Diamond Designation™ Program

Program Year 2024 Overview

The Diamond Designation™ Program provides ratings information on the quality and efficiency of care for practice groups across 14 specialty areas. Quality is emphasized over efficiency in the Program and is primarily based on specialty type-specific quality measures sourced from third-party organizations. Efficiency of care evaluation is based on medical condition-based episodes of care. Results for both quality and efficiency are determined at a provider group level, based on the group’s Tax ID number. Individual practitioners inherit the practice group’s designation results from the Program.

The Diamond Designation™ Program aims to provide information that can potentially assist primary care providers in making more informed decisions for specialty care referrals. Also, exclusive to the Buckeye Health Plan Medicaid network of providers, a listing of Diamond Designated providers is made available to potentially help inform specialty care provider selection for Medicaid members in Ohio.

PCPs consider many factors when recommending or referring members to another provider for specialty care. Similarly, members have many factors to consider in their choice for specialty care providers. We inform primary care practices and Buckeye Health Plan Medicaid members that all relevant factors should be considered, and information from the Program should not be the sole basis of their decision-making. The Program is not used for the purposes of pay-for-performance.

Email or fax notifications are sent out to specialty providers who are rated in the Program at least 60 days before Program results are made available. Results will be made available for sharing with the primary care community of providers, as well as Buckeye Health Plan Medicaid members on July 9, 2024, the effective date for Program Year 2024. You may request the results of your evaluation by contacting ContactUs@DiamondDesignation.com. Evaluated providers may also request reconsideration of their results before they are shared with primary care providers or Buckeye Health Plan members in Ohio, if such requests are received before June 9,2024.

Evaluated specialty areas for the 2024 Diamond Designation™ Program include:

  • Cardiology                                                                          
  • Counseling                                                                         
  • Endocrinology
  • Gastroenterology
  • General Surgery              
  • Nephrology
  • Neurology
  • Obstetrics/Gynecology
  • Ophthalmology
  • Orthopedic Surgery        
  • Podiatry
  • Psychiatry          
  • Psychology        
  • Pulmonology   

How Results are Displayed

Quality is the primary dimension for Program evaluation. Quality designation is reflected by a Diamond DesignationTM icon. Efficiency ratings are represented by a one-to-five star range and are only displayed if the specialty provider has met the threshold to achieve the Diamond quality designation of the Program. The absence of a quality or efficiency result for a provider should not be construed to suggest that they do not provide quality or efficient healthcare services. Reasons a provider may not have results for quality or efficiency include, but are not limited to:

  • The provider practices in a specialty that is not included in the Diamond Designation™ Program; 

            or

  • There is insufficient data to meet minimum sample size requirements for statistical evaluation.
  • The Program is limited to certain geographies and specialties evaluated within each state can vary. Currently, the Program includes providers in Connecticut, Florida, Georgia, Hawaii, Kentucky, Maine, Mississippi, New Jersey, Ohio, and Tennessee.

Additional Program Information and Feedback Process

The below materials offer additional detail on the Diamond Designation™ Program. Further information is also available upon request by emailing the Diamond Designation™ Team at ContactUs@DiamondDesignation.com: 

During development of the Program, input was sought from consumers, purchasers, physicians and other clinicians on the Program’s measures and measurement activities, as well as the usefulness of the Program’s public reporting. This feedback was collected across various advisory and member committees, as well as meetings and communications with health plan purchasers. All feedback has been analyzed for opportunities to improve the Program. If you have feedback, questions, or need assistance, you may reach the Diamond Designation™ Team at ContactUs@DiamondDesignation.com.

Complaints? If your patients have
a complaint about the Diamond Designation™
Program, they may register a complaint with us by contacting their health plan directly. Buckeye Health Plan Medicaid members should reference https://www.buckeyehealthplan.com/members/medicaid/resources/complaints-appeals.html. Buckeye Health Plan MyCare Ohio (MMP) members should reference https://mmp.buckeyehealthplan.com/appeals-grievances.html.

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, exclusive to Buckeye Health Plan Medicaid 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 Medicaid 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 Wellcare. Providers are solely responsible for the treatment and outcomes of their patients. Physicians participating in Wellcare networks have met specific minimum credentialing requirements. Wellcare members have access to providers in the Wellcare  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 Wellcare 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 Wellcare.