Provider Finder® to Rank Providers to Help PPO Members Find Care

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. 

If you have questions, contact PEAQ Inquiries. The full PEAQ methodology is on our PEAQ page