Optimizing Network Performance
Network performance can be optimized when population concerns are addressed with high-value services delivered by quality providers and members are steered towards most cost-efficient systems.
To achieve this goal, our solution works on top of your existing PPO networks – and creates virtual, personalized, high performance networks around the key concerns of member population.
These High-performance networks (HPNs) are not just narrow networks, rather these are designed around each care pathway, and address unsupported treatment variances between providers, to optimize outcomes, quality and costs.
How does it work?
We construct a deep understanding of the activity going on within your existing network and analyze it to figure out how to improve performance – like understanding when and why members are seeking care outside the network. Given the member population, geographic service area, and overall population health management strategy, do we have the right types of physicians, services and programs in our network?
By analyzing data on claims and measurable quality, we identify physicians, hospitals, services and programs whose data reflects high performance. After additional analysis, such as reviewing the partner relationships, network adequacy, strategic importance, etc. – we focus on optimizing the network for quality and financial performance and reducing waste, abuse, inefficiency and fraud.