Introduction of the HPP designation program for individual member (Exchange) commercial networks

Anthem informed you in a previous newsletter that we were implementing a new High Performing Provider (HPP) designation to care providers meeting certain cost and quality metrics as part of our expansion of consumer tools and programs. We informed you that initially the designation will focus on certain types of professional providers we categorize as primary care providers (PCPs), but it may be broadened to include other care provider types in the future.

Beginning October 31, 2024, Anthem will be using a new HPP methodology (cost and quality metrics) to designate HPPs for PCPs participating in our individual member (Exchange) plan networks that service our Affordable Care Act plans (IND HPPs). The new IND HPP methodology will be tailored for our Exchange plans.

The methodology we notified you about in the newsletter article (where a link to the methodology was included) will continue to be used for our non-Exchange commercial health plan networks.

As with the non-Exchange HPP designation, Anthem may highlight Exchange HPPs in various ways, including, but not limited to:

• Offering special opportunities to participate in product offerings.
• When members contact Anthem with requests for referral options.
• Placing a designation in the Care and Cost Finder. This would be in addition to Anthem’s existing tool in Care and Cost Finder, called Personalized Match, which provides Anthem members with the option to search for in-network care providers through a specialized sorting tool that considers certain cost and quality metrics as well.
• Personalized Match search results sorting, similar to how the HPP methodology for non-Exchange PCPs impacts Personalized Match rankings. You may review a copy of the Personalized Match methodology for Exchange PCPs posted on Availity – our secure web-based provider tool – using the following navigation: Go to Availity > Payer Spaces > Health Plan > Provider Online Reporting > Programs > Personalized Match Methodology.pdf.
• A factor in auto assignment PCP methodology for health benefit plans that require a member to pick a PCP and the member fails to do so.

The IND HPP methodology for determining an IND HPP is similar to the methodology for determining an HPP PCP in general (which services the health plan’s large and small group commercial populations); however, certain metrics may solely apply to the individual member population. The IND HPP designation is solely for PCPs seeing an individual member population and is not for specialists.

You can view the IND HPP designation methodology here. For more information on the individual HPP designation, or to know if your practice will receive the individual HPP designation, please contact Provider Services or your local provider relationship management representative.  

Look for further updates on the IND HPP designation in this newsletter. To sign up for this newsletter, go to https://providernews.anthem.com, select the appropriate state, and then select Subscribe to Email in the top right corner.