Most health plans include network of providers that deliver fragmented care with no single entity managing a system or tracking and monitoring a member through the continuum of care.
The economics of this system is a weighted spend average of where everyone goes rolled up into one effective premium. You have your most cost-efficient health systems subsidizing the least cost-efficient health systems, which are also their competitors.
Some plans have now started offering narrow provider networks that offer lower premium rates, but these lower-cost networks do not necessarily mean high performance. For example, an alternative network could be designed based on a plan receiving better contracts from the providers offered in its narrow network product. Low premiums for health programs, therefore, do not necessarily mean the care is delivered in a high quality, efficient manner.

Optimizing Network Performance

Virtual network

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?

How. to optimize network performance

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.

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‘Pay for Value’ to drive better care at lower costs