Provider Profiling
Analyze cost, utilization, quality and patient satisfaction metrics by provider
Cost per Episode
$1,847
Benchmark: $2,100 ▼ 12% better
Utilization Rate
87%
vs Network Avg: 100% ▼ 13% lower
Quality Score
8.4/10
Network avg: 7.6 ▲ 10.5% above
Patient Satisfaction
4.2/5
Target: 4.5 ▼ 0.3 below target
Utilization Trends — 12 Months
Per 1,000 Members
Admits/1K
ER Visits
Specialist Refs
Cost Comparison — Cost per Episode
This provider is in the top 25th percentile for cost efficiency.
Projected annual savings vs benchmark: $317,450
HEDIS Quality Measures
| HEDIS Measure | This Provider % | Network Avg % | Target % | Status |
|---|---|---|---|---|
| Diabetes HbA1c Control (<8%) | 76% | 68% | 70% | Met |
| Blood Pressure Control (<140/90) | 71% | 74% | 75% | Near Miss |
| Breast Cancer Screening | 82% | 76% | 80% | Met |
| Colorectal Cancer Screening | 69% | 71% | 72% | Near Miss |
| Medication Adherence — Statins | 84% | 79% | 80% | Met |
| Well-Child Visits (3–6) | 91% | 85% | 85% | Met |
| Depression Screening | 58% | 62% | 65% | Below Target |
| Childhood Immunization Status | 88% | 82% | 85% | Met |
Risk-Adjusted Performance Score
Composite score normalizing for patient population complexity and acuity
84.2
0 — Low255075100 — Excellent
Avg RAF Score (Panel)
1.74
Network avg: 1.62
Case Complexity Index
2.3x
vs network avg 1.8x
Outcome Score (adj.)
91.3
Rank: 3 of 47 peers
Methodology: The risk-adjusted performance score accounts for patient age, chronic condition burden (HCC count), socioeconomic factors (SDOH index), and geographic access. A provider treating a higher-acuity panel who achieves the same raw outcomes as a peer treating healthier patients will receive a higher adjusted score. This score is recalculated quarterly using CMS HCC model v28.