Helping Ambetter members connect with a primary care physician (PCP) they actually want to see
When members enroll in a non-gatekeeper Ambetter plan, a primary care physician is automatically assigned to them. They're never required to visit that doctor — and overwhelmingly, they don't. The assigned PCP rarely matches a member's location, language, or needs, so the relationship never begins.
A self-service experience to help Ambetter health plan members choose a primary care physician they actually want to see — replacing an auto-assignment system that most members quietly ignored.
The numbers that defined the problem
Why this matters
Members on non-gatekeeper plans aren't required to see their assigned PCP — so when the assigned doctor doesn't match their needs, preferences, or location, they simply don't go. The result is missed preventive care, more ER visits, out-of-network spend, and a growing administrative burden on the organization.
Baseline numbers — where we started
The low numbers pointed to a single missing thing: choice. Members had no voice in who their doctor was, and no easy way to fix it without picking up the phone. If members could select a PCP based on their own needs and preferences, they'd be far more likely to actually go — improving care, lowering cost, and deflecting the calls that came from forcing a default on them.
Executive Summary