Understanding Methodology for Aetna Smart Compare Program

This document is a guide that outlines the methodology for the Aetna Smart Compare program, which analyzes physician organizations using commercial claims data to provide members with information about quality and effective physicians in their networks. It describes the clinical quality gate used to evaluate providers and the communication of designated providers to members. The guide details the specialties included in the program for 2026, such as Allergy & Immunology, Behavioral Health, Cardiology, and others. It explains the quality gate process, which assesses physician performance against benchmarks to determine effectiveness and designation. Additionally, it discusses the thresholds for program eligibility and the exclusion of pediatric physicians from most specialty programs, while highlighting exceptions. The document emphasizes the importance of statistical significance in measuring physician performance and outlines the criteria for designation and evaluation outcomes.