Challenges
This directory, which showcases all possible providers for a given geography and specialty, applies a ranking system to surface relevant providers within the search interface and guide member choice. As such, when a member inputs their desired geography, procedure, or specialty, the directory returns an ordinal list of providers to consider.
Uncovering top providers to prioritize in the search results presents many challenges. Often, plans ground these search rankings in basic factors, such as provider location and availability. These factors, while critical, provide no visibility into the cost and outcomes performance.
How we helped
To ensure members connect with the highest quality providers possible, the plan partnered with Arcadia CareJourney for rigorous provider performance insights, grounded in transparency.
Arcadia CareJourney’s Provider Intelligence offers cost and quality scores, powered by clinically relevant episodes of care, to enable end-users to easily sort and identify high-performing providers.
The plan integrates these insights into their ranking algorithm to easily prioritize provider quality alongside other factors, like distance from a patient and availability.
Additionally, the plan prequalifies provider groups for their networks before extending contracts with Arcadia CareJourney performance data. This ensures high-performing networks for members from the start.
Impact
For this particular member, this meant:
- Enhanced member search experience for 100,000+ members
- Improved alignment and decision making to top providers
- Reduced episodic cost of care and improved quality
More importantly, since incorporating these insights, members have shared positive feedback. In fact, several members noted that the additional insights into how providers treat their specific conditions prompted a better understanding of their care options, better selection of a provider, and more confidence in their treatment.
We strive to provide the best care by connecting our members with providers who are first in class. To do that, we rely on CareJourney provider scores as part of a ranking system, alongside other factors, to prioritize the right type of care for our members when they search for a provider.
VP, Provider Network Strategy at large health plan
Lessons Learned
1. Location and availability alone aren’t enough
Provider directories built only on these factors give members no way to gauge quality or cost.
2. Transparent cost and quality scores change member behavior
When members can see performance data, they report more confidence in their provider choice.
3. Performance data has a second use beyond search
The plan applied the same scores to prequalify provider groups before extending network contracts, not just to rank search results.
4. Episode-based quality scoring translates to member-facing tools
Clinically relevant episodes of care can power a consumer search experience, not just internal analytics.
5. Member trust follows from explainability
Members who understood why a provider ranked higher made more confident choices, suggesting the “why” behind a ranking matters as much as the ranking itself.
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