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Provider Benchmarking

Every year, UPMC Health Plan Behavioral Health Services sends benchmarking reports to our providers to let them know how they are doing in certain areas related to the services they provide to members. These reports include network averages and goals, when possible.

The benchmarking reports include measures of inpatient mental health services and inpatient drug and alcohol services. The providers who offer these services are informed about:

• How many members are readmitted to their hospital within 30 days of discharge,
• How many members have a follow-up appointment within 7 and 30 days of being discharged from their hospital and
• The average number of days for members to have a follow-up appointment after discharge.

UPMC Health Plan Behavioral Health Services measures these items because we believe that members who have timely follow-up appointments after discharge have a lower chance of being re-admitted to the hospital and a better chance of recovery.

If a provider’s rate significantly differs from the established quality benchmark, the provider is asked to submit a written explanation about why the rate is so different and to identify interventions they could implement so that their rate for the following year could improve.

Benchmarking reports are sent to UPMC Health Plan Behavioral Health Services providers once a year. For more information on provider benchmarking, please call UPMC Health Plan Behavioral Health Services at 1-888-251-0083 and ask to speak to a Quality Representative. TTY users can call 1-877-877-3580.

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