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performance threshold

perf_thrsh_pct
quality·Updated Jun 23, 2026

Definition

ISO-11179 Definition

The minimum quality measure rate or cost efficiency score that a provider or health plan must achieve to qualify for shared savings distributions, quality bonus payments, or favorable contract terms in value based care arrangements. Performance thresholds function as gates that must be cleared before financial rewards are accessible — providers who fail to meet minimum quality thresholds may be ineligible for shared savings even if they successfully reduced total cost of care below benchmark. CMS MSSP requires ACOs to meet minimum attainment levels on quality measures before receiving any shared savings distribution.

Medicare Advantage plans must achieve minimum star ratings to receive quality bonus payments. Commercial value based contracts establish performance thresholds for each quality domain with progressive bonus tiers that increase with higher performance. Healthcare data teams track perf_thrsh_pct values by contract and measure, calculate current performance against thresholds throughout the measurement year, identify measures at risk of falling below minimum thresholds requiring immediate intervention, and model the financial impact of threshold attainment or failure on total contract settlement amounts.

Standard Abbreviation

perf_thrsh_pct

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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