Provider Reports

Each quarter, a participating practice can access a report that details how it performed against the requirements of the patient centered medical home programme. Those requirements are linked directly to the practice's qualification for care coordination and shared savings incentive payments, so the report is not simply feedback: it is the record that determines whether a practice receives the payments it has worked for.

When reports appear

Reports are published on the provider portal approximately six weeks after the close of each quarter. That delay is deliberate, because it gives the payers time to gather claims and portal data, check that the information is complete and calculate the measures before a practice sees them.

Because the reports appear on a regular schedule, practices can plan around them. A team that reviews its report soon after publication has the rest of the quarter to act on anything that looks weak, rather than discovering a problem only when the year has ended.

What a report shows

A report sets out a practice's performance against the programme requirements described in the PCMH manual. Those requirements cover the care coordination and quality expectations that the programme places on enrolled practices, and they are the same requirements that determine whether incentive payments apply.

The report is designed to be read with a companion guide that explains how to interpret each section using an illustrative example. The guide matters because a performance report combines several kinds of information, and understanding which part drives a payment decision is essential to knowing where to focus.

Samples and guides

Sample reports are available so that a practice can see the layout before its own results arrive. A sample quarterly report and a sample pooling report are both provided, each with its own guide explaining how to read the figures and how the pooling of results works across a group of providers.

Reviewing a sample first lets a practice decide who on the team should read which section, and it turns the arrival of the real report into a routine review rather than a puzzle.

Using reports to improve

The point of a performance report is to change behaviour. A practice that sees a measure slipping can investigate the workflow behind it, adjust how care is coordinated and check whether the change shows up in the next quarter, which is a shorter feedback loop than most quality programmes offer.

Reports also help a practice understand its position relative to the requirements as a whole. Because the requirements are tied to payments, the report connects a clinical or operational detail to a financial result, which is precisely the link the payment initiative was built to create.

A report is most useful when the whole team sees it. A practice that shares the relevant sections with the people who influence the measure, from the front desk to the nursing staff to the prescribing clinicians, tends to find that change happens faster than when the report is read only by an administrator. The companion guides help here, because they explain each part in plain terms so that a colleague who is not an analyst can still see what the measure is asking for and what the practice's number means.

What a practice can expect

• A performance report for each quarter of participation.
• Publication on the provider portal roughly six weeks after the quarter closes.
• Measures tied to care coordination and shared savings eligibility.
• A guide explaining how to read each part of the report.
• A sample report and a sample pooling report for reference.
• Guides for both the quarterly report and the pooled report.

Reports and supporting documents

Report content, timing and the requirements behind it are reviewed as the programme develops, so practices should confirm the current reporting calendar and measure definitions in the official programme materials and on the provider portal.