July 2022
Physician Efficiency, Appropriateness, and QualitySM (PEAQSM) Program: Provider Questions and Other Resources
We’re preparing to roll out our PEAQ program to Illinois providers soon. Until then, we’ll continue to publish articles in the Blue Review to keep you informed. Meanwhile, for an overview of PEAQ, see answers to general questions about the program below.
What is PEAQ?
The Blue Cross and Blue Shield of Illinois (BCBSIL) PEAQ program looks at physician performance in a transparent and multidimensional way. Physicians who practice in PEAQ specialties and meet minimum patient criteria will receive Physician Performance Insights (PPI) that show how they were evaluated and where they rank in comparison to their peers in the same geographic area and working specialty.
To what networks, provider types and specialties will PEAQ apply?
PEAQ performance applies to all networks. Physicians (M.D.s and D.O.s) will be measured at the individual National Provider Identifier (NPI) level. BCBSIL looks at three specialties and 15 corresponding working specialties:
- Medical – Cardiology, Endocrinology, Gastroenterology, Nephrology, Obstetrics/Gynecology, Pulmonary, Rheumatology
- Surgical – Cardiothoracic Surgery, Ophthalmology, Orthopedic Surgery, Urology, Vascular Surgery
- Primary Care – Family Medicine, Internal Medicine, Pediatrics
In the future, PEAQ may expand to include other provider types and levels, such as physician groups.
How will physicians be evaluated?
Data used is either claims-based or obtained from feeds such as labs. The program does not include a review of medical records. Physicians will be evaluated in the three performance components (Efficiency, Appropriateness, and Quality) and their measures will be consolidated into an overall metric. Efficiency and quality ratings are risk-adjusted based on multiple factors, such as patient comorbidities, demographics, disease severity, and disease category.
The benchmark will be a provider’s peer group defined by working specialty and geographic region. We will continually evaluate measured specialties based on data availability, clinical relevance, and volume. PEAQ results will be updated once annually. The evaluation frequency is subject to change.
For more information on physician evaluation, refer to the program methodology on the PEAQ page in the Provider Tools section of our website. More resources will be added to our website as the program evolves.
How will PEAQ results be used?
PEAQ will be used to help physicians understand how they’re performing relative to their peers. We believe this is very important to physicians. PEAQ may be used to help connect BCBSIL members with high-performing physicians.
If you have other questions about the program, contact our PEAQ team.
For announcements and related resources, continue to watch the Blue Review and News and Updates.
The above material is for informational purposes only and is not intended to be a substitute for the independent medical judgment of a physician. Physicians and other health care providers are encouraged to use their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment.