Summary
This document is a technical report detailing the Aetna Smart Compare methodology for analyzing physician practices using Commercial plan data. It outlines the process for evaluating physician quality and effectiveness, ensuring that designated providers meet specific clinical quality metrics before being included in member outreach initiatives. The report describes the various specialty programs available in 2025, including Behavioral Health, Cardiology, and General Surgery, among others. Each program has defined quality gates to assess physician performance, and the report specifies the volume thresholds required for statistical significance in evaluations. Additionally, it explains the attribution logic used for determining which physician is responsible for episodes of care based on surgical procedures and visit records. The methodology aims to provide actionable information to members regarding high-quality and effective care within their plan networks, while also detailing the exclusions and criteria for pediatric physicians.
