Using claims data to select primary care physicians for a managed care network.
An insurance claims databased profiling system was developed to help select new primary care physicians (PCPs) for a managed care network. PCPs (family practitioners, internists, and pediatricians) were ranked based on how closely their actual use of outpatient services conformed to the predictions of a mathematical model that adjusted for differences in age, sex, and case mix.
Aetna Health Plans, Hartford, CT.
P
P
Nathanson
M
M
Noether
R J
RJ
Ozminkowski
K M
KM
Smith
B E
BE
Raney
D
D
Mickey
P M
PM
Hawley
D000553:Ambulatory Care / Q000145:classification / Q000706:statistics & numerical data; D003406:Credentialing; D003627:Data Interpretation, Statistical; D016208:Databases, Factual; D003659:Decision Making, Organizational; D003953:Diagnosis-Related Groups; D005260:Female; D006801:Humans; D007344:Insurance Claim Reporting; D008297:Male; D008329:Managed Care Programs / Q000592:standards; D010560:Personnel Selection / Q000379:methods* / Q000592:standards; D010821:Physicians, Family / Q000592:standards* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D014481:United States; D000078329:Workforce