Clinical Quality

Physician Quality Profiler®

For nearly 20 years we have been analyzing data and finding opportunities to improve the quality of care.

Our clinical quality measures are based on evidence-based guidelines for many specialties.

The RHI Physician Quality Profiler® compares performance of different physicians in a statistically meaningful way to:

  • Improve the transparency of physician quality
  • Increase physician compliance with evidence-based guidelines
  • Support pay-for-performance and other innovative payment models
  • Support the design of tiers and performance-based provider networks

We use claims data to evaluate the quality of care delivered by individual physicians and physician groups. The Profiler attributes responsibility for the management of each covered health plan member's clinical issues to the appropriate physician(s). The Profiler also provides state-of-the-art statistical analyses to support quality profiles and comes with a complete reporting package.

Provider-Specific Quality Reports

  • Quality score and profile by quality measure for individual physicians and physician groups
  • Physician performance is evaluated within single health plan or across multiple plans

Condition-Specific Quality Reports

  • Composite scores by clinical condition (e.g., diabetes) or type of care (e.g., prevention) for physicians or physician groups

Member-Specific Detail

  • Health plan members whose care was not consistent with best practice guidelines are identified, allowing providers to validate findings and improve performance