How We Choose Preferred Providers

What is a preferred provider?

Preferred providers are vetted, trusted and experienced care providers. We compare costs and measure quality of care to find out who delivers the most efficient care for our members.

Cost efficient

We compare the cost and performance of primary care provider groups that coordinate care with other provider groups within specific regions.

Quality of care

The NCQA establishes national quality factors called HEDIS measures. These measures include more than 90 healthcare quality standards and cover six areas that focus on improving the quality of health

care.

  • Effectiveness of care
  • Access and availability of care
  • Experience of care
  • Utilization and risk adjusted utilization
  • Health plan descriptive information
  • Measures reported using electronic clinical data systems

Read more about HEDIS measures. 

Choice

To help ensure that members have choices, we identify multiple preferred providers in each area.  

HEDIS®, which stands for Healthcare Effectiveness Data and Information Set, is a registered trademark of the National Committee for Quality Assurance, or NCQA.

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Page Last Updated Tue Aug 20 08:48:00 EST 2024