Innovative Health Plan Enhances Member Provider Directory With CareJourney Provider Intelligence
A tech-forward health plan – aims to improve the experience and lower the cost of care for Medicare Advantage beneficiaries. To achieve their goals, they deploy a member-facing provider directory facilitating choice and identifying top providers for their beneficiaries.
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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 CareJourney Helped
To ensure members connect with the highest quality providers possible, the plan partnered with CareJourney for rigorous provider performance insights, grounded in transparency.
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 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.
100,000+
Enhanced Member
Search Experiences
“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