July 23, 2024
Later this year, Provider Finder will add a tiering feature that shows how providers rank against peers in their working specialties in some PPO products. The tier will display only for members in employer groups with a tiered benefit option. Members can use this information to take advantage of incentives such as lower copays and coinsurance for care from high performers.
Tiering is based on composite results of the Physician Efficiency, Appropriateness, & QualitySM program. This evidence-based program evaluates primary care physicians and some specialists on components of cost efficiency, medical appropriateness and quality of patient care.
Tiering applies to providers in the following specialties:
| Medical | Surgical | Primary Care |
Cardiology Endocrinology Gastroenterology Nephrology Obstetrics and Gynecology Pulmonary Medicine Rheumatology |
Cardiothoracic Surgery Ophthalmology Orthopedic Surgery Urology Vascular Surgery |
Family Medicine Internal Medicine Pediatrics |
- Tier 1 has lower member out-of-pocket costs. It includes behavioral health providers and physicians who have above average composite scores as compared to their peers.
- Tier 2 has standard member out-of-pocket costs. It includes unscored providers* and physicians who have average composite scores as compared to their peers.
- Tier 3 has higher member out-of-pocket costs. It includes physicians who have below average composite scores as compared to their peers.
Tiering in 2024 is based on previous PEAQ results. Tiering in 2025 will be based on 2024 PEAQ results.
*Unscored providers include those practicing in specialties evaluated by PEAQ who did not reach minimum criteria thresholds and those who practice in specialties that PEAQ does not currently evaluate.