Diamond Designation™ Program Overview

Program Year 2024

The Diamond Designation™ Program rates certain specialty care providers on the quality of care that they provide for members. Specialty providers receive the Diamond Designation^TM rating for higher quality of care. Buckeye Health Plan – MyCare Ohio (Medicare-Medicaid Plan) members can find Diamond Designation^TM specialty providers in an online listing.  The Program will be updated approximately every year to provide more recent rating results. The 2024 version of the Program will be released on July 9, 2024. On that date, the online listing will be available at mmp.buckeyehealthplan.com/find-a-doctor.html.

Ratings from the Program are determined at a provider group practice level so the individual specialists within the practice group will receive the same rating as the whole group. This is because there usually are not enough cases for an individual specialist to be reasonably rated through the Program. Rating at a provider group level allows more providers to be rated and allows you to understand the overall rating for the whole specialty group practice.

Information from the Diamond Designation™ Program may also be shared with primary care providers who often help members with specialty care selection and decisions.  An additional rating on the specialty group’s efficiency of care is also made available to primary care providers. However, this additional rating on efficiency is only available for those specialty groups who receive the Diamond Designation^TM, higher-quality rating.

Ratings from the Program should serve as guide in selecting specialty care and should not serve as the sole basis for specialist provider selection. You should consider all factors in making decisions for specialty care and you are also encouraged to consult with your primary care physician when selecting a specialist. As a member of Buckeye Health Plan, you have a choice of providers that are in our network of physicians and other clinicians who provide specialty care. Information from the Diamond Designation^TM Program is not used in provider pay-for-performance programs.

The absence of a rating for a specialty provider does not mean that they do not provide quality or efficient healthcare services. There are several reasons why a specialty provider may not have quality or efficiency ratings from the Program including:

1. The provider practices in a specialty type or sub-specialty that is not included in the Diamond Designation^TM Program.
2. The provider is in an area of Ohio where the Diamond Designation Program is not available.
3. There was not enough data to rate the provider.

Specialty types included in the Program vary by state, as do the counties where the Program operates. The specialties and counties available for Buckeye Health plan members are listed below:

Additional Program Information and Feedback Process

Please see the Diamond Designation™ Program website for more details at DiamondDesignation.com. Further information is also available upon request by emailing the Diamond Designation™ Team at ContactUs@DiamondDesignation.com.

If you have feedback or have questions about the Diamond Designation^TM Program you may reach the Diamond Designation™ Team at ContactUs@DiamondDesignation.com. We collect and review all feedback from members and providers for potential improvements to the Program.

Complaints? If you have a complaint about the Diamond Designation™ Program, you may register a complaint with us. If you are a MyCare Ohio (MMP) member please see Buckeye Health Plan Member Complaints Info.

Important Notes about the Diamond Designation™ Program

The Diamond Designation™ Program makes quality and efficiency rating information available for potential use by primary care providers. Such information can help inform referral decisions for specialty care. Also, for Buckeye Health Plan – MyCare Ohio (Medicare-Medicaid Plan) members in Ohio, a listing of Diamond Designation™ providers is made available online to potentially help inform specialty care provider selection. Quality is emphasized over efficiency in the evaluation process. Primary care providers and Buckeye Health Plan – MyCare Ohio (Medicare-Medicaid Plan) members are advised that ratings from the Program should not

serve as the sole basis for specialist provider selection. We evaluate specialty provider quality and efficiency for in-network providers at a practice group level based on tax identification number. The current Program evaluates 14 specialty types: Cardiology, Counseling, Endocrinology, Gastroenterology, General Surgery, Nephrology, Neurology, Obstetrics/Gynecology, Ophthalmology, Orthopedic Surgery, Podiatry, Psychiatry, Psychology, and Pulmonology.

Physicians are solely responsible for evaluating the needs of members and directing them to the most appropriate healthcare services. The Diamond Designation™ Program does not, in any way, certify the quality or efficiency of care that members receive from providers who are included in Program evaluations, nor should information from the Program be considered, in any way, as an endorsement of a particular provider or such provider’s delivery of care. Ratings from the Diamond Designation™ Program are only a partial evaluation of quality and efficiency and should not solely serve as the basis for specialist provider selection (as such ratings have a risk of error). Other factors may be important in the selection of a specialist. Neither participating specialists nor referring providers are agents of Buckeye Health Plan. Providers are solely responsible for the treatment and outcomes of their patients. Physicians participating in Buckeye Health Plan networks have met specific minimum credentialing requirements. Buckeye Health Plan members have access to providers in the Buckeye Health Plan network according to their benefit plan and are not limited to certain providers based on ratings from the Program. The Program and its results are not utilized to determine payment under Buckeye Health Plan pay-for-performance programs.

The Program is based on national standards including the emphasis of quality over efficiency of care, and is developed with feedback from consumers, purchasers, physicians, and other clinicians. Specialty provider groups who are rated within the Program may, pursuant to Program policies, request a change or correction to information used to determine their quality or efficiency ratings. The absence of any quality or efficiency rating should not be construed to suggest that a provider does not provide quality or efficient healthcare services. Reasons a provider may not have a rating available for quality or efficiency include but are not limited to: 1) The provider practices in a specialty or geography that is not included in the Diamond Designation™ Program; or 2) There is insufficient data to meet minimum sample size requirements for statistical evaluation. The rating methodology of the Diamond Designation™ Program is subject to change from year to year. The information contained in this Program Overview is subject to change at the discretion of Buckeye Health Plan.

Buckeye Health Plan – MyCare Ohio (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees.

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