Tag Archives: Medica

26 Northfield area doctors rated highly by Medica on quality and cost-efficiency. Is it helpful? Is it fair?

Medica Premium Designation

Today’s Strib: Medica posts controversial doctor ratings

For the first time, the Medica health plan today began publicly rating thousands of Minnesota doctors on its website, Medica.com, in an effort to give consumers more information on their health care providers. The state’s second-largest insurer is using a "star system" to indicate which doctors meet certain thresholds for quality and cost-efficiency in 20 medical specialties.

Medica posted the ratings Wednesday in spite of pleas from the Minnesota Medical Association (MMA) to delay publication. The MMA says the system is prone to errors and unfair to doctors. Medica used three years’ of patient claims data to determine which doctors adhere to national treatment guidelines, and which have higher than average costs.

The MMA has posted a release on it’s website titled: MMA finds significant errors in Medica’s physician rating program

After reviewing the Medica Premium Designation Program, the MMA raised three serious concerns about the program: a lack of reliability testing to assure statistical accuracy in physician results, a lack of Minnesota physician involvement in the development of the rating program, and a woefully inadequate timeline for physicians to review their results and the data underlying their results.

You can search the database to find how individual doctors scored (1 star for quality, 2 stars for cost and quality).

My screencapture image on the right is the result of searching all providers within 5 miles of zip code 55057. The results came back with "More than 100 providers met the preferences you selected. The closest 100 have been returned." I then sorted those by name and listed them all on one page. Click the image, and then after the larger image pops up, click the green arrow to enlarge it further.

I counted 26 Northfield area physicians on that list of 100 with 2 stars on the Medica Premium Designation system which says:

Northfield Physicians rated by MedicaLook for the stars. Find the care you deserve. When you’re looking for a physician, simply look for the stars. They mark physicians who have met standards for quality and cost-efficient care.*

One star means a physician has met nationally recognized standards for delivering high quality care.

Two stars means a physician has been recognized not only for providing quality care, but also for meeting local benchmarks for providing cost-efficient care to their patients. They meet or exceed nationally recognized guidelines, and they’re more likely to recommend the right tests and treatment at the right times.

How do you benefit from all this? It’s simple – a doctor with two stars has proven he or she delivers value.

Your plan does not require you to use Premium Designation physicians, but when you do, your total costs for the treatment of a condition will be on average 10-20% less.

Premium Designation physicians, as a group:

  • Have lower surgery repeat rates
  • Follow nationally recognized guidelines for care, and
  • Are more likely to be aware of the latest research and clinical trials.