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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:

Selection Process and Criteria

Providers do not need to apply. Embold uses data from the source of a Health Verity claim that covers over 160 million lives. The sample represents commercial and their associated managed plans such as Medicare Advantage and Medicaid managed plans. The provider review period runs from January 1-March 30 of each year. ​Should you have any questions or comments on the selection process, please email the Healthcare Policy and Benefits Division at CARE.COMPASS@CT.GOV.

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Effective January 1 –  June 30, 2024

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Clinical Criteria for Quality Scoring By Service

As part of Embold Health’s standard provider evaluation rules, a provider must have at least 10 observations in the data period for their measure score to be included in their quality score, and to be evaluated overall, a provider must have at least 4 clinical quality measures and at least 1 cost measure. To be considered for the specific clinical domains used for the State of Connecticut program, they must have at least 30 observations across the relevant measures listed below. All measures a provider is scored on are combined into the quality score used for the program (further described below). Provider evaluations are on a peer comparison basis, relative to the Market Average, which is at the State Level.

Endoscopy and Colonoscopy
  • ED visit within 7 days after colonoscopy
  • Adenoma detection rate in screening colonoscopy
  • ED visit within 7 days after upper endoscopy
  • Admission within 7 days after upper endoscopy
  • Repeat screening colonoscopy within 1 year.
  • Upper and lower endoscopy on separate days
  • Upper endoscopy overuse in GERD patients without alarm symptoms
  • Upper endoscopy use in GERD patients with alarm symptoms
Maternity Care
  • Cesarean delivery rate in low-risk delivery
  • Percent of stays of 3 days or less
  • Transfusion after delivery in low-risk pregnancy
  • ICU admission within 30 days after delivery in low-risk pregnancy
  • Infection after delivery in low-risk pregnancy
  • ED visit or readmission within 30 days after delivery in low-risk pregnancy
  • Overly frequent use of ultrasounds in low-risk pregnancy
  • Receipt of appropriate prenatal testing
  • Overly frequent use of forceps or vacuum in low-risk pregnancy.
  • Overly frequent use of episiotomy in low-risk pregnancy
  • Follow-up for behavioral health diagnosis
Hip Care and Hip Replacement
  • PT within 4 months prior to hip replacement
  • Overly frequent use of preoperative stress testing
  • MRI within 4 months prior to hip replacement
  • PT within 4 months prior to elective hip arthroscopy
  • SNF admission after hip replacement
  • Surgical revision after hip replacement
  • Hip replacement within 1 year of new osteoarthritis diagnosis.
  • MRI in the first year after diagnosis of hip pain
  • PT in the first 4 months of new hip pain
  • Opioid prescribing within 28 days in patients with new joint pain
  • Complication rate after hip replacement
Knee Care and Knee Replacement
  • PT within 4 months prior to knee replacement
  • Overly frequent use of preoperative stress testing
  • MRI within 4 months prior to knee replacement
  • PT within 4 months prior to elective  knee arthroscopy
  • SNF admission after knee replacement
  • Surgical revision after knee replacement
  • Arthroscopy overuse in patients with new osteoarthritis
  • Knee replacement within 1 year of new osteoarthritis diagnosis.
  • MRI in the first year after diagnosis of knee pain
  • PT in the first 4 months of new knee pain
  • Opioid prescribing within 28 days in patients with new joint pain
  • Complication rate after knee replacement
Spine Pain Management
  • PT within 4 months prior to cervical spine surgery
  • PT within 4 months prior to lumbar spine surgery
  • Surgery within 1 year for new lumbar degenerative disc disease
  • Surgery within 1 year for new cervical degenerative disc disease
  • Surgery within 1 year for new lumbar pain
  • Surgery within 1 year for new cervical pain
  • PT in the first 4 months of new lumbar spine pain
  • PT in the first 4 months of new cervical spine pain
  • Opioid prescribing in patients with new lumbar spine pain
  • Opioid prescribing in patients with new cervical spine pain
Lumbar Spine Surgery
  • PT within 4 months prior to lumbar spine surgery
  • Skilled nursing facility admission after lumbar spine surgery
  • Complication rate after lumbar spinal surgery
  • Hardware removal after lumbar spine surgery
  • Surgery within 1 year for spondylolisthesis
  • Surgery within 1 year for new lumbar degenerative disc disease
  • Surgery within 1 year for new lumbar pain
  • PT in the first 4 months of new lumbar spine pain
  • Opioid prescribing in patients with new lumbar spine pain

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

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.

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