Enhanced personalized match: making the care provider search more informed and personalized

Summary:

• The Personalized Match sorting option in the Find Care tool will be enhanced to provide more personalized care provider suggestions based on gaps in care and member history derived from clinical data, beginning December 2024.
• Members will be able to find details on the enhanced Personalized Match methodology in the online directory, and care providers will be able to submit inquiries or request reconsideration of care provider scores.

Find Care, the provider finder and transparency tool in the Anthem online directory, allows members to search for in-network care providers using the secure member website at anthem.com/find-care. This tool currently offers multiple sorting options, such as sorting providers based on Personalized Match, distance, alphabetic order, and care provider name.

Beginning December 2024 or later, the Personalized Match sorting option will be enhanced for members. This sorting option currently considers care provider efficiency and quality outcomes. Enhancements will include gaps in care, such as HEDIS^® measures and other market-specific clinical care measures, knowledge about member history derived from claims and other available clinical data, and member search radius. Care provider pairings with the highest overall ranking within the member’s search radius will be displayed first. Members will continue to be able to sort based on distance, alphabetic order, and care provider name:

• You may review a copy of the Personalized Match methodology that has been posted on Availity Essentials — our secure web-based care provider tool — using the following navigation: Go to Availity.com > Payer Spaces > Select the Payer > Provider Online Reporting > Programs > Select a Program > Personalized Match > Personalized Match Methodology Phase 2 - Medicaid.pdf.
• If you have general questions regarding this new sorting option, please submit an inquiry to Availity.com.
• If you would like information about your quality or efficiency scoring used as part of this sorting option or if you would like to request reconsideration of those scores, you may do so by submitting an inquiry to Availity.com.