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high performance network

hi_perf_ntwk_ind
quality·Updated Jun 23, 2026

Definition

ISO-11179 Definition

A boolean indicator identifying a curated provider network composed exclusively of providers who have demonstrated measurably superior quality outcomes and cost efficiency relative to peers, used in value based insurance designs to channel members toward highest-value care. High performance networks apply rigorous data-driven selection criteria including top-quartile HEDIS quality rates, below-benchmark total cost of care, board certification, and superior patient safety records to identify the subset of providers who deliver the best combination of quality and efficiency. Members enrolled in high performance network products receive the most favorable cost sharing but must use designated high performance network providers for covered services.

Healthcare data teams support high performance network development by calculating composite performance scores across quality, safety, efficiency, and patient experience domains, applying selection thresholds to identify qualifying providers, modeling network adequacy for the high performance network against regulatory access standards, and tracking member and volume migration to the high performance network over time.

Standard Abbreviation

hi_perf_ntwk_ind

Category

quality

Production DDL — FACT_QUALITY_MEASURE

FACT_QUALITY_MEASURE.sql
CREATE OR REPLACE TABLE FACT_QUALITY_MEASURE (
    qlty_key        INTEGER        NOT NULL  -- surrogate key,
    mbr_key         INTEGER        NOT NULL  -- FK to DIM_MEMBER,
    plan_key        INTEGER        NOT NULL  -- FK to DIM_PLAN,
    meas_yr         SMALLINT                 -- measurement year,
    hedis_meas_cd   VARCHAR(20)              -- HEDIS measure code,
    denom_ind       CHAR(1)                  -- denominator eligible,
    numer_ind       CHAR(1)                  -- numerator met,
    excl_ind        CHAR(1)                  -- exclusion indicator,
    gap_open_ind    CHAR(1)                  -- care gap open,
    star_rtg_nbr    DECIMAL(3,1)             -- star rating,
    qlty_scr        DECIMAL(5,2)             -- quality score,
    perf_thrsh_pct  DECIMAL(5,2)             -- performance threshold,
    raf_scr         DECIMAL(10,3)            -- risk adjustment factor,
    outreach_cnt    SMALLINT                 -- outreach attempts,
    load_dt         TIMESTAMP_NTZ  NOT NULL  -- load timestamp
);

Standard Snowflake DDL for the canonical quality table. Convert to BigQuery or Databricks →

Why This Term Matters

Quality measure data determines how payers and providers are rated and reimbursed under CMS Stars, HEDIS, and value-based care contracts. Data engineers who understand quality terminology build measure calculation pipelines that correctly attribute patients, apply denominator exclusions, and flag documentation gaps before submission deadlines. Incorrect quality data directly affects star ratings, pay-for-performance bonuses, and Medicare Advantage plan bids.

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