Specialist Performance Initiative

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.

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.

If you have questions regarding SPI, submit your inquiry to SpecialistPerformance@highmark.com.

Last updated on 11/18/2022 3:42:35 PM


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