Provider Excellence Program
MVP has established the MVP Provider Excellence Program to provide our physicians and members relevant quality and cost data to help them make informed health care decisions.
The purpose of this new program is to identify and recognize high-quality, cost-efficient providers to:
- Create awareness of high-performing providers within the MVP network
- Provide additional support to strategic provider groups
- In the future, the results may inform MVP products and program benefits
Specialties and Measures
Only in-network, Participating Providers that are contracted with MVP in New York State are evaluated under the Provider Excellence Program. To reduce the risk of measurement error, all providers are assessed using nationally recognized, evidence-based recommendations and guidelines that have been vetted for statistical validity and reliability, as well as industry accepted clinical episode grouper software. Learn which specialties and measures are included in the 2021 program.
MVP began publicly reporting high-quality and cost-efficient providers who offer internal medicine and family medicine services to its members in February 2020. In January 2022, MVP updated the list of designated providers to reflect the most current calculation of scores.
Methodology Overview
The Provider Excellence Program scoring methodology applies only to MVP’s commercial members, excluding Administrative Services Only (ASO) members who do not have full pharmacy benefits, Essential Plan members, and members for whom MVP was not the primary payer. MVP evaluates quality and cost efficiency information using a methodology that is consistent with national standards and incorporates feedback from health care professionals in our network. Each evaluated provider group receives a quality and cost efficiency score based on how they compare to their peers. All comparisons of performance on quality and cost efficiency are based on a 95% confidence level. See an overview of the methodology.
To request the full methodology, email ProviderExcellence@mvphealthcare.com.
What This Means for You and Your Patients
In addition to members being able to see which MVP participating providers have scored the highest for quality and cost efficiency, provider scores may be utilized for plan or network design.
While reimbursement is unchanged because of a provider group’s evaluation, the public reporting of quality and cost efficiency is intended to encourage individuals to consider using a high value provider. MVP informs members that this evaluation should not be the only factor considered when making a health care decision as this is only a partial assessment of quality and cost efficiency. We encourage members to consider all relevant factors when choosing a provider and to speak with their Primary Care Provider (PCP) when selecting a specialist.
Frequently Asked Questions
2021 Provider Excellence Program Changes
How do I provide feedback about the program?
How do I request detailed group results and/or detailed scoring methodology?
How do I request a correction or reconsideration?