High Performing Provider Designation Criteria

This document is a technical report detailing the criteria and processes for the High Performing Provider (HPP) designation awarded by Anthem Blue Cross and Blue Shield to Primary Care Providers (PCPs) within its networks. The report outlines the metrics used to evaluate PCPs based on cost efficiency and quality of care. It explains that the HPP designation serves as a guide for members in selecting providers but should not be the sole consideration. The evaluation process includes assessing individual providers and provider groups based on their performance during a specified Measurement Period. The report also describes how cost and quality scores are calculated, including the use of aggregated claims data and clinical quality measures. Additionally, it details the thresholds that must be met for a provider group to receive the HPP designation and the adjustments that may be made based on various factors. The report emphasizes the importance of aligning with state-level quality initiatives and the criteria for inclusion and exclusion of provider groups in the evaluation process.