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#Idea - ‘Suggest a Doctor’ - Improve Member’s Provider search experience


Why: Finding a healthcare provider is a painful exercise. Tools like ‘Find a Provider’ are useful, but still require a Member to spend considerable time to decide which doctor fits his needs well. Here is a blog I wrote that details ‘why’ 

What: A doctor recommendation tool that suggests / recommends doctors that fit our member’s needs, preferences and insurance plans.

How: We have information / data about what providers members choose (either PCPs or specialist in a PPO plan). We also have demographic data about each of our member and details of which providers are preferred based on the insurance plan they have. We also have clickstream data of how member searches to find a provider that works for him / her. This data can also be combined with Claims to determine which provider ended up visiting. Combining these sources and using ‘predictive analytics’ we can narrow down the list of providers that fit member’s requirements and present a list of suggested providers to help member’s provider search experience better.  

Over time, our tool will become better at suggesting doctors using past experience (which provider we had suggested, and which provider member ended up choosing). 

We can also make this ‘suggestion tool’ better if we are able to tap into provider review data (either from third party or from feedback we collect from our members).


Potential roadblocks:
We need to ensure that we remain compliant with all rules and regulations. Couple points to consider as mitigation of any compliance risks:
  • We may have to create an new entity separate it from our core business and ensure that we do not have conflicts of interest with our members
  • We may be able brand the tool, not as 'suggest a doctor', but as 'people like you, chose these doctors'. (Not sure if this is inline with how we should act as an insurance company, but helping people choose a doctor is the intent of this idea).





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