Methodology for Aetna Smart Compare Program

This document is a guide detailing the methodology for the 2025 Aetna Smart Compare program, which analyzes physician organizations using commercial claims data. The program aims to provide members with actionable information regarding high-quality and effective physicians within their plan networks. It outlines the criteria for designating providers as high-quality based on clinical quality gates and effectiveness metrics. The guide specifies the specialties included in the program, such as Behavioral Health, Cardiology, and General Surgery, along with the volume thresholds necessary for statistical significance. Additionally, it describes the attribution logic used to assign episodes of care to specific physicians, ensuring that evaluations are based on defined performance metrics. The document also addresses the exclusion of pediatric physicians from certain measures and the criteria for identifying them. Overall, this methodology serves as a framework for assessing physician performance and ensuring quality care for Aetna members.