Highmark’s Specialist Performance Initiative (SPI) provides cost and quality insights to eligible specialists and True Performance primary care physicians (PCPs). SPI includes ranking information on over 11,000 specialists in 14 clinical specialty groupings and 52 clinical condition categories giving Highmark’s network brand new insights into performance to help them provide and guide our members to the highest value care possible. SPI includes the following specialties: cardiologists, dermatologists, endocrinologists, general surgeons, gastroenterologists, gynecologists, nephrologists, neurologists, ophthalmologists, orthopedic specialists, psychologists, pulmonologists, rheumatologists, and urologists.
All eligible specialists will be ranked based on observed/expected (O/E) performance scores within various clinical condition categories.* Specialist profiles enable comparisons of the relative cost of care among providers who practice in the same region and specialty. The specialist profiles will be based on four Highmark service areas – Western, PA; the combined Central and Northeastern, PA regions; West Virginia and Delaware and include health system physicians and independent doctors, including Highmark partners.
*While all eligible specialists will receive an O/E performance score, some specialists may be excluded from the list rankings shared with third party specialists and PCPs for contractual reasons.
SPI is an informational only cost performance profile tool to help physician groups monitor care cost. It is not a reimbursement program at this time.
Please refer to the links below for more information about SPI:
Specialist Performance Initiative Overview
Frequently Asked Questions
Access to the profile tool is available online from the Provider Facing Analytics link on NaviNet. You will need to create an account in order to view your secure, encrypted, and password-protected data. A step-by-step guide to obtain access has been provided for your convenience.
PFA Reference Guide
If you have questions regarding SPI, submit your inquiry to SpecialistPerformance@highmark.com.
Last updated on 2/24/2021