Introduction of the Specialty High Performing Provider designation program for commercial networks

In a previous newsletter, Anthem informed you 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. In that communication, we indicated that the designation will initially 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.

Effective on or about December 1, 2024, Anthem will use a new HPP methodology (cost and quality metrics) to designate certain specialists as High Performing Providers.

The methodology we notified you about in the newsletter article (where a link to the methodology was included) will continue to be used for the designation of PCPs. That methodology has been revised to apply to specialists.

As with PCP HPP, Anthem may highlight specialist HPPs in various ways, including, but not limited to:

• 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 Essentials — 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.

As shown in the specialty HPP methodology, the specialty methodology for determining a specialty HPP closely mirrors the methodology for determining an HPP PCP.

To view the specialty HPP designation methodology which includes a listing of specialties included, please click here. For more information on the specialty HPP designation, or to find out if your practice will receive the specialty HPP designation, please contact Provider Services or your local provider relationship management representative.

Look for further updates on the specialty 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.