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 ~12,000 California physicians in March 2017. 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 Summer 2015. The Review & Corrections period for the Cycle 2 data occured during Fall 2016.

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 had the opportunity to visit the portal to review and correct their results from 9/8/16 - 11/11/16. 

For details on attribution and other methodological items, please see our Rating Methods. For questions, please email chpicorrections@pbgh.org.

Physician Performance Ratings

Healthcare decisions 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 March 2017 for Californians to compare providers..

Consumers will be able to use our performance ratings to answer questions such as the following:

  • For patients who take ongoing medications, how often do doctors regularly monitor these medications?
  • For patients with chronic disease, such as diabetes or heart problems, how often do doctors consistently track patients' symptoms and provide recommended treatments?
  • How often do doctors meet the highest standards for seeing that their patients are regularly screened for cancer?
  • For children with common respiratory illnesses, how often do doctors avoid exposing children to unnecessary antibiotics?

Methods

CHPI is committed to providing accurate, meaningful information to help consumers and healthcare purchasers make better health care decisions.

We follow strict 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 measurement science. 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; and,
  • Alignment with the Patient Charter and NCQA's Physician and Hospital Quality (PHQ) certification program.