PBH develops and distributes individual provider profiles
for those providers that meet a threshold for members seen
within a specified time period. A profile shows summary performance
data for a provider for a specified time period. The Profile
is divided into three sections. The first section, Outpatient
Activity During the Report Period, provides descriptive information
related to the specified provider's treatment of PBH members.
The second section, Quality Indicators, shows provider-specific
results on nine performance measures in comparison to PBH
targets. These targets were set by PBH at a level that represents
excellence in customer service based on PBH historical data
and industry standards. The third section of the Profile,
the Level of Care Summary, describes the extent to which PBH
members treated by the provider also received higher levels
of care. The Profile indicators are summarized below.
Provider Profile Indicator Descriptions
Outpatient Activity
Members Treated
Members with a Provider Assessment Report (PAR)
PAR-Based Case-Mix Summary
Quality Indicators
Percentage of members age 12 or younger with at least
one family visit
Percentage of members satisfied with their provider (because
only a random sample of members is surveyed, many providers
will not have sufficient data for reporting. PBH has set
a minimum threshold of five (5) completed surveys for this
measure to be reported.)
Percentage of members satisfied with their provider's
availability for appointments (Because only a random
sample of members is surveyed, many providers will not have
sufficient data for reporting. PBH has set a minimum threshold
of five (5) completed surveys for this measure to be reported).
Percentage of members seen within 10 business days of
routine referral
Percentage of referred members not seen within 30 days.
Complaint rate
Percentage of members receiving coordination of care
Percentage of members with an MD consultation
Level of Care Summary
Number and percentage of members receiving a higher level
of care
