Provider Connect

Provider Connect is Included Health’s proprietary provider matching capability, fully integrated into our all-in-one platform. It combines a data-driven match engine, AI-powered personalized engagement, and a high-touch concierge experience to guide members to the right, high-quality, cost-effective provider the first time. It is available as part of two Included Health products: All-Included Care and Navigation.

Carrier directories and most provider search tools return a generic list of in-network providers sorted by distance or star ratings, with no insight into clinical quality, cost-effectiveness, or individual fit. Provider Connect is fundamentally different in four key ways:

1. Personalization. We dynamically tailor recommendations for each member based on their unique clinical needs and preferences. Machine learning weights quality and relevance using claims, electronic health records, app activity, conversations with our AI agent, and member context to predict best‑fit providers.
2. Clinical depth. Our match engine uses robust quality measures across all specialties and subspecialties, aligned with NCQA/HEDIS‑like constructs for safety, expertise, efficiency, and price.
3. Accuracy. Our data is 3 times more accurate than carrier directories, filtering out providers with wrong addresses, incorrect specialties, or closed panels.
4. End-to-end support. Our engagement model doesn’t stop at search. Our AI agent, Dot, and our care teams follow members through discovery, scheduling, and beyond to drive engagement and follow-through. Moreover, Provider Connect is fully embedded in our highly rated app, so we can also guide members to other relevant benefits and provide wraparound clinical, administrative, and financial support.

The impact is measurable and consistent across our book of business:

• $700 average savings per converted referral in Year 1 — rising to $2,100 over five years
• 92% increase in member connections to top-quartile providers
• 33% lower rates of repeat spine surgery
• 38% lower rates of repeat knee replacements
• 64% reduction in likelihood of high-dose opioid prescribing
• 39% higher rates of psychotherapy for members with anxiety or depression

Individual results vary by population and engagement levels. Included Health provides annual business reviews with full visibility into engagement rates, provider connection quality, and attributable savings.

Provider Connect goes well beyond demographics. We combine clinical history from claims and EHR data with real-time signals — app activity, prior searches, and live conversations with Dot or our care team — to build a dynamic profile of each member’s needs and preferences. Our condition-specific predictive models then weight quality measures accordingly, so two members in the same household searching for the same specialty receive different, individually tailored recommendations. We find not just the best doctor, but the best-fit doctor for each member.

Yes. Provider Connect spans the full range of specialties members need, including behavioral health. Our quality measures for behavioral health evaluate providers on prescribing safety, appropriate use of psychotherapy, and outcomes for conditions including anxiety and depression.

Yes. Provider Connect’s single, explainable quality score is the foundation for tiered network design.

Yes. An independent study conducted by researchers at Veracity Analytics found that Included Health’s top-ranked primary care physicians provided significantly higher-quality care that was clinically meaningful and statistically significant across all evaluated metrics. This external validation distinguishes our approach from competitors that rely solely on internally generated data or subjective patient reviews.