State of Connecticut and Embold Providers of Distinction

The state of Connecticut health plan is working with Embold Health, a physician-led healthcare analytics company, to update our list of high-performing doctors in our Providers of Distinction program. 

Primary Goals in Establishing Providers of Distinction Criteria:

• Clinical specifically relevant to the existing/legacy Providers of Distinction program
• Emphasize higher quality over lower cost, but still consider both.
• Balance the approach of setting a high standard for inclusion, while considering member access to providers who would qualify for the benefit.

Selection Process and Criteria

Providers do not need to apply. Embold Health uses a National dataset covering 200M+ lives, including Commercial, Medicaid, and Medicare Advantage. The provider review period runs from January 1 – March 30 of each year. Some providers’ scores fell 10 percentage points below the criteria. These providers must meet the threshold by the next review period, or they will lose their designation starting July 1, 2025. Should you have any questions or comments on the selection process, please email the Healthcare Policy and Benefits Division at CARE.COMPASS@CT.GOV.

Search Selected Providers

Effective November 15, 2024 – June 30, 2025.

Clinical Criteria for Quality Scoring By Service

Embold Health creates scores for Providers of Distinction. For confidence, their standard requires a provider to have at least ten observations (in the data period) to be scored in a measure, and at least four clinical quality measures plus at least one cost measure to be scored overall.  Furthermore, to be considered for the clinical focus scoring used for the State of Connecticut program, they must have at least 30 observations across the relevant measures listed below.  Cost and quality measures for each Provider of Distinction are combined for overall Quality and Cost scores for use in the program criteria (further described below). Scores are created by comparing measure rates to the national peer group average and rank ordered for CT.  

Summary of the Embold criteria and the estimated number of Providers of Distinction:

• For all services except Maternity Care and Knee Care and Knee Replacement, the Quality Criteria is 60th Percentile or above on the relevant quality score and 50th Percentile or above on their cost score. For Maternity Care and Knee Care and Knee Replacement the Quality Criteria is 70th Percentile and 50th Percentile above on their cost score.
• For Hip care and Hip Replacement, Knee Care and Knee Replacement, and Lumbar Spine Surgery, there is an additional criterion: confirmation that the provider specifically performs Hip, Knee, or Low Back surgery, respectively. This is done via independent validation in Embold’s claims data source.
• The state of Connecticut will promote the Provider of Distinction program to its plan members through various marketing campaigns, including this member-facing Providers of Distinction webpage. Members can also use the ‘Find Provider’ tool to locate providers as needed, which displays the selected provider’s “Provider of Distinction” recognition.

If you would like more detailed information about your scoring or how to improve your scoring to become a Provider of Distinction, please review the FAQs, visit  emboldhealth.com/solutions/physicians, or email care.compass@ct.gov.