Procedure searches in Find Care
Sorting provider searches
The algorithms used to sort provider searches use a combination of member and provider features to sort and display the results for a member’s search. The sorting results take into account member factors such as the member’s medical conditions and demographics.
Quality and compliance for provider searches are based on over 100 quality of care rules that monitor member prevention, medication, diagnostic testing and various additional aspects of care based on HEDIS and other process metrics that are proven indicators of the pursuit of high quality care. Quality rules are updated periodically as standard of care guidelines evolve (applies to specialist/provider searches).
Sorting procedure searches
The algorithm used to sort procedure searches also takes into account provider factors such as surgeon-facility pairing (an individual provider who performs a procedure at a specific facility), cost efficiency measures, volumes of patients treated across various disease conditions, and outcome-based quality measures.
Combined member and provider features generate a unique ranking of surgeon-facility pairings or facility providers for each member conducting the procedure search. Displayed first are surgeon-facility pairings with the highest overall ranking within the search radius. Remaining pairings are displayed in descending order based on overall rank and proximity to the center of the search radius.
Changes coming in May
- Adding maternity related searches to our suite of Find Care Personalized Match surgeon-facility/provider and procedure searches. Maternity searches will contain updated quality scoring to reflect separate scores for C-section and vaginal delivery.
- Standardizing the procedure search methodology such that the groupers used across all procedures are consistent.
- Adding a new provider search capability for Physical Therapy/Occupational Therapy.
Access Availity to review updated methodology
You may review a copy of the updated methodology by going to Availity and then using the following navigation:
Payer Spaces > Anthem > Information Center > Administrative Support >Personalized Match Search Methodology.pdf.
If you have general questions about the Find Care tool or the change to the quality measures for procedure searches, please contact your local Empire consultant.
If you would like detailed information about quality or cost factors used as part of this unique sorting or you would like to request reconsideration of those factors, you may do so by emailing firstname.lastname@example.org or by calling 833-292-2601.
April 2022 Newsletter