Provider Efficiency, Appropriateness, & Quality Program

Our Provider Efficiency, Appropriateness, & QualitySM  program evaluates provider performance in a transparent and multidimensional way. Its goal is to work with providers to maximize efficiency, appropriateness, and quality of care. BCBSNM initially developed PEAQSM with input from practicing providers and continues to collaborate with providers to improve the program.

PEAQ program guiding principles include:

  • Metrics – Selecting meaningful measures that are evidence-based and nationally recognized to evaluate provider performance
  •  Transparency – Sharing details to help providers understand how the program works and ways it can support efficiency, appropriateness and quality of care for our members
  • Collaboration – Partnering with providers to ensure measurement transparency and clinical relevance
  • Continuous improvement – Reevaluating our methodology and measures regularly based on provider feedback and recent clinical evidence
  • Insights – Giving provider-level reporting to help improve overall performance
  • Member focus – Using PEAQ program results to help our members identify providers who are right for them

For more information, refer to the PEAQ Methodology. Questions? Check our PEAQ FAQs for answers or contact PEAQ Inquiries.

Methodology

Provider Performance Insights:  The PPI is a periodic report containing personalized feedback on care for our members over a recent interval. PPIs show how a provider was evaluated and where they rank in comparison to peers. PPIs also include actionable insights to improve future performance.

PPI PDF reports are loaded on Availity® Essentials for qualified providers. Refer to the Availity User Guide for information on viewing reports and the Report User Guide for details about report construction. Not registered for Availity? Sign up now by going to Availity and selecting “Register” in the top right corner. 

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSNM. BCBSNM makes no endorsement, representations or warranties regarding any products or services provided by third party vendors.