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 this program.
Beginning in February, MVP will publicly report high quality and cost efficient providers who offer internal medicine and family medicine services to its members.
The Provider Excellence Program scoring methodology applies only to MVP’s commercial members, excluding Administrative Services Only (ASO) members, 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 as a result 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 Physician (PCP) when selecting a specialist.
Frequently Asked Questions
How do I provide feedback about the program?
MVP is committed to working with our providers and we welcome your feedback as we continue to enhance the Provider Excellence Program. To provide feedback about this program, please contact your Professional Relations (PR) representative, or email ProviderExcellence@mvphealthcare.com, or take our survey.
How do I request detailed group results and/or detailed scoring methodology?
Email ProviderExcellence@mvphealthcare.com to obtain detailed group results or request the detailed scoring methodology. Your PR representative can provide a copy of the full MVP Provider Excellence Program scoring methodology upon request.
How do I request a correction or reconsideration?
To request corrections or reconsideration, email ProviderExcellence@mvphealthcare.com, contact your PR representative, or send a request by mail to:
MVP Health Care
Attn: Provider Excellence Program
625 State Street
Schenectady, NY 12305
All requests for correction must include documentation to support the correction.
Requests received within 21 days of the date on the initial notification will be investigated upon receipt. Written notification will be sent to the provider describing the outcome of the investigation before an updated designation is made publicly available.
Requests received after 21 days of the date on the initial notification will be investigated and the provider will be notified in writing within 30 days of receipt of a reconsideration request.
Please note, while the window for reconsideration for 2019 scores has ended, MVP will recalculate results on an annual basis.