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Medica Administrative Manual > Health Management and Quality Improvement > Quality and Cost Transparency

Quality and Cost Transparency

Transparency of Provider Data for Consumers

As required by law and discussed in the provider participation agreements, network providers must comply with all reasonable requests by Medica for information that Medica intends to release to purchasers of health care coverage, Members and other consumers, including without limitation, provider-specific quality, outcomes and patient satisfaction data. Prior to its release of provider-related administrative, clinical health improvement or other performance data, Medica will provide each provider with an opportunity to review any such data; provided, however, that Medica will have sole discretion and authority over (a) the content of such data for purposes of accurately disseminating data relating to the performance of the provider, and (b) the release of any such data. Providers consent to the release by Medica of such information, and providers will not attempt to prohibit or restrict Medica's release of such information.

Provider Quality and Efficiency Measurement Programs

In addition to dissemination of consumer data about providers in its network, Medica is also involved in a number of provider measurement initiatives. Some of these provider measurements are required by applicable law and others are related to other community and Medica specific programs or product structures (including but not limited to Minnesota Community Measurement and the Medica Premium Designation Program). These provider measurement programs may include provider tiering and possible benefit plan designs with member liability differentials based on the measurement results.

Medica will strive to design its measurement programs with consideration of the principles of the National Committee for Quality Assurance (NCQA) standards for Physician and Hospital Quality measures, which include:

  • Standardization and Sound Methodology — allowing results to be compared across organizations.
  • Transparency — offering practitioners the opportunity to provide input on measurement programs and providing clear and coherent information regarding how results will be used.
  • Collaboration — when feasible, pooling data with other organizations to produce results with greater statistical reliability.
  • Action on Quality and Cost — cost measurements will never be the sole source for a comprehensive measurement program so that organizations will not sacrifice quality for cost.

Medica Premium Program

The Premium Program provides physician designations based on quality and cost-efficiency criteria to help members make more informed choices about their medical care. Physicians may also use these designations when referring patients to other physicians and to support their efforts to provide quality and cost-efficient care to their patients.

Medica's Premium Program includes both quality and cost-efficiency evaluations with quality serving as the primary measurement. This emphasis on quality demonstrates a commitment to evidence-based medicine as only those physicians who meet quality criteria are evaluated for cost efficiency. The results of these evaluations are used together to determine a designation that is displayed to members on Medica's provider search tool.

Administration of the Premium Program is handled by UnitedHealthcare®.

For additional assistance, please visit UnitedHealth Premium®.

Main Street Medica

This site provides members with cost and quality details on things such as procedures, conditions, and health care supplies, which allows them to compare providers.

Visit Main Street Medica.

REV 9/2021

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