Multi-Payer Claims Database (MPCD)
Learn more about the MPCD: Physician Review and Corrections | Physician Performance Ratings | Methods
CHPI administers the only Multi-Payer Claims Database (MPCD) currently in operation in California and consists of claims from the state’s three largest health plans and the Medicare fee-for-service program.
CHPI includes both insured and self-funded PPO, HMO and Medicare Advantage claims and encounters from Anthem Blue Cross, Blue Shield of California, and UnitedHealthcare, representing ~7 million patients. These data provide information on services provided by hospitals, emergency departments, ambulatory surgery centers, ancillary providers, pharmacies, and physicians.
In addition, CHPI was designated as a Qualified Entity (QE) through the Medicare Data Sharing Program in February 2013. CHPI has received Medicare fee-for-service claims representing ~3 million California beneficiaries, and has integrated these claims with its private health plan claims data. As part of the QE program, the federal Centers for Medicare & Medicaid Services (CMS) have reviewed and approved CHPI's methods to rate physicians, process for physicians to review and correct their results, and plans to publish ratings for the public.
In all, CHPI will aggregate administrative claims and eligibility data for approximately 10 million lives across California to create physician performance ratings.
Physician Review and Corrections
CHPI will publish two “cycles” worth of quality information on ~13,000 California physicians in December 2016. Cycle 1 information is based on measurement year 2012, and Cycle 2 information is based on measurement year 2014. The Review & Corrections period for the Cycle 1 data occurred during the summer of 2015. The Review & Corrections period for the Cycle 2 data is currently underway.
On September 9, 2016, CHPI mailed reports to the physicians included in the Cycle 2 results. The mailed report contains the registration token needed to register an account on the online Review & Corrections Portal. Physicians have the opportunity to visit the portal to review and correct their results from 9/8/16 - 11/11/16. A tutorial on how to register an account on the portal and submit corrections is here.
Physicians can check whether they are included in the Cycle 2 results by clicking here. Physicians who are included in the results but did not receive their mailed report containing their registration token should email [email protected] and include 1) their state license number in the subject line and 2) their practice address in the email. Once CHPI validates the address, CHPI will re-mail the report to the address.
For details on attribution and other methodological items, please see our Rating Methods. For more information, please see our FAQ or our introductory video. For questions, please email [email protected].
Physician Performance Ratings
Choosing a doctor can be confusing. Too often, consumers either don't know where to find information on the quality and value of care offered by providers, or the information they find is too limited. To fill this gap, CHPI will publish performance ratings in December 2016 for Californians to compare providers side-by-side and choose ones who offer higher quality and value.
Consumers will be able to use our performance ratings to answer questions such as the following:
- For patients who take ongoing medications, which doctors regularly monitor these medications to ensure their patients’ safety?
- For patients with chronic disease, such as diabetes or heart problems, which doctors consistently track patients' symptoms and provide treatments to keep their patients in the best health possible?
- Which doctors meet the highest standards for seeing that their patients are regularly screened for cancer – to detect problems early when they can best be treated?
- For children with common respiratory illnesses, which doctors avoid exposing children to the possible harm of using antibiotics that are unnecessary and don't work?
Methods
CHPI is committed to providing accurate, meaningful information to help consumers and healthcare purchasers make better health care decisions.
Because our MPCD represents services received by over 10 million Californians, no other source can provide a more complete picture of health care value in California. We protect this confidential information by following information technology standards and privacy laws regarding the secure storage, usage, and transmission of sensitive healthcare information. We calculate provider ratings by applying rigorous methods based on the measurement science.
The end product will be a trustworthy and comprehensive source of information that Californians can use to choose doctors or learn more about their current providers.
The following are key features of our methods. For more information, download a full description here.
- Three years of aggregated claims and administrative data from three California health plans and the Medicare fee-for-service program;
- Extensive data quality testing and assurance processes;
- Nationally endorsed performance measures;
- Risk-adjustment for patient demographics and insurance type;
- Statistical reliability testing;
- Comparable provider peer groupings;
- Statewide performance benchmarking;
- Physician review and feedback before results are publicly released;
- Performance scoring standards to ensure the accuracy of the results; and,
- Alignment with the Patient Charter and NCQA's Physician and Hospital Quality (PHQ) certification program.