Performance Rating
Helping you make informed health care decisions
Finding the right primary care provider (PCP) goes a long way for your health. Our Find Care tool includes a rating system for members. 1 It offers objective scoring based on three categories, as well as member ratings and comments.
BlueCross Performance Rating
How we calculate our provider ratings
The BlueCross Performance Rating compares how PCPs perform on three factors:
60%
of the provider's score comes from how well they meet health and wellness standards.2
20%
of the provider's score comes from how efficiently they deliver care.3
20%
of the provider's score comes from managing patients' total care through our Medical Home Partnership program.4
Find a Provider
How our ratings work
Have questions about how the BlueCross Performance Rating works? These answers might be what you're looking for.
-
If a provider doesn’t have a BlueCross Performance Rating and/or a Patient Experience rating, does that mean they’re not a good provider?
No, not at all. Even high-performing providers may not have a rating. There are several reasons a provider might not have a BlueCross Performance Rating:
- They’re new to our network.
- We don’t have enough information about them yet to accurately reflect their performance.
- They’re a specialist, not a PCP.
If a provider isn’t a PCP, the BlueCross Performance Rating won’t appear in their profile at all. For primary care providers who don’t receive a BlueCross Performance Rating, you’ll see a message that says “Not Yet Rated” in place of a star rating.
Likewise, if a provider doesn’t have a Patient Experience rating, it doesn’t mean they’re a bad provider. It just means no one’s left a review yet. To make sure that the reviews you see are from patients with real, firsthand experience, members can only leave a Patient Experience rating for providers they’ve actually seen.
-
I understand the BlueCross Performance Rating is limited to PCPs, but are there any other tools that will help me pick a specialist or facility?
While the BlueCross Performance Rating focuses on PCPs, we know it’s important to highlight other high-quality, high-value providers. Our online tools include filter options that allow you to sort search results by Tennessee providers who participate in local and national quality programs, such as Medical Home Partnership, Oncology Medical Home, Blue Distinction® Specialty Care and Total Care. These programs are highlighted by designated logos within the provider profile.
Centers for Medicare and Medicaid Services (CMS) Quality Ratings are incorporated in our online Find Care tool for participating hospitals. These ratings are included within the provider profile for several hospital facilities who have reported quality performance measures to CMS.
Nationally, there are online tools also available on the Blue Cross Blue Shield Association’s provider finder that can help you find high-quality, high-value providers outside of Tennessee that participate in national quality programs such as Blue Distinction Specialty Care and Total Care.
In addition, our front-line staff can recommend specialists by performing a provider search based on specific criteria, including your network, distance from your home address, and if the specialist is accepting new patients.
Can these ratings change over time?
Yes. Each year, we’ll review providers’ BlueCross Performance Rating and make adjustments based on the most recent information. This gives you the most accurate picture of providers’ performance, while also letting providers maintain or improve their scores.
Patient Experience ratings update every time a member leaves a new review.
How do I leave a review for my provider?
Go to bcbst.com to log in to your account and select the claim on file for that provider. You can then click Review this Provider to leave a rating. You may also add comments to the review to give more detail about your experience. Your name will be confidential and display as “Verified Patient” to protect your privacy.
Want to see our rating system?
Log in to learn more, or call us at the Member Service number on the back of your Member ID card.
Footnotes
-
Not available to members in Medicare or BlueCare plans
-
A high rating shows the provider performs preventive tests and prescribes treatments that are consistent with medically recommended care.
-
We rely on evidence-based measures developed by board-certified, academically affiliated physicians, nurses and pharmacists to measure this performance.
-
A five-star rating means the provider is in our Medical Home Partnership (MHP) program. An MHP provider can help you get the best results and save unnecessary costs by managing and coordinating your care with all your other health care providers.
- ${title}${badge}