HealthCorum Scores

Scoring Methodology

HealthCorum applies a combination of evidence-based clinical guidelines, clinical review, analysis of unwarranted variation and specialty-specific definitions of low value care to develop the risk-adjusted, population-based metrics that define its value scores. Each provider is assigned to a peer group of similar providers based on their specialty, an analysis of their medical and pharmacy claims data, and their Hospital Referral Region (HRR). Metrics are calculated for each provider, then scored and ranked into quintiles based on how they compare to their peers.

Score Components

Overall Quality Score 

Combines the three component scores measuring effectiveness, cost, and appropriateness into a single value score. A higher rating shows which providers are most likely to follow best practices and achieve better outcomes at lower cost compared to their peers.

Effectiveness Score 

Includes evidence-based measures of quality, patient safety, and outcomes. A higher rating shows adherence to clinical guidelines and better patient outcomes compared to other similar doctors. 

Cost Efficiency Score

Includes cost of diagnostics, procedures and medications. The cost score can be interpreted as “resource efficiency” score. The derived cost metrics are based on the Standard-Risk Adjusted costs derived from RVUs, APCs, DRGs, NDCs metadata aligned with procedures. They are monetary equivalents for the resource use and are not based on actual costs and are designed to complement our overall value even with the presence of actual costs coming from the price transparency negotiated rates. A higher rating reflects the use of less costly options and/or more conservative decision-making compared to other similar doctors. 

Appropriateness Score 

Includes tests, procedures, and medications that are prone to overuse, often unnecessary, provide little or no value for the patient, increase downstream utilization and cost, and can even lead to harm. A higher rating indicates a greater proportion of medically necessary care and less low-value care compared to other similar doctors.