Quest Analytics Suite™
Adequacy Module

The Next Level of Healthcare Network Analysis

Building on the Quest Analytics Suite's industry-leading Access Analysis capabilities, we've taken the industry to a whole new level with the Adequacy Analysis Module.

Does Your Network Stack Up?

Adequacy analysis combines dynamic time and distance access standards with minimum provider requirements for dozens of individual specialties and specific services performed at facilities. It has also revolutionized the way servicing providers are identified by allowing all network providers within the desired proximity of a beneficiary location to be considered in the analysis regardless of geographic boundaries.

The Quest Analytics Suite utilizes a template-driven approach to defining an adequacy analysis, making it possible to leverage industry standard templates such as those for Medicare Advantage or to define your own custom adequacy analysis. In addition, you can drill down into your results with features such as:

  • Flexible Adequacy Detail Reports by Various Levels of Geography
  • Robust Mapping Capabilities to Identify Gap Areas
  • Standardized Data Elements such as County SSA Code
  • Quick Identification of Potential Invalid Addresses
  • Hospital Service Line Data to Augment your Database
  • Easy Specialty Translation to CMS Standards

While the Adequacy Analysis Module's roots began with the Medicare Advantage program, this same functionality can be leveraged to meet other Federal, State and commercial needs such as:

  • Measuring Qualified Health Plans (QHPs) for State-based Exchanges
  • Adopting Medicaid specific requirements for Network Adequacy
  • Meeting Accreditation Standards for an Adequate Network

Medicare Advantage (Part-C and Part-D)

Medicare Advantage

You can be sure your health plan meets the Medicare Advantage Network Adequacy requirements by using the same tool utilized by CMS to approve service area expansions (SAE) - insuring apples-to-apples results. The Adequacy Analysis Module includes standard templates with Medicare Advantage Part-C and Part-D Pharmacy requirements preprogrammed for you, so you can just feed in your data and run a report to see how you will score prior to submitting your data to CMS.

In addition, the Adequacy Analysis Module also provides you with the ability to export MA Provider and MA Facility tables (a.k.a. HSD Tables) directly from your provider groups in the required format for upload to HPMS - with many of the required columns pre-populated and the providers automatically filtered to include all potential servicing providers. You can rest assured that your data is as complete and accurate as possible.

State of Florida - Managed Medical Assistance (MMA)

The Adequacy Analysis Module has also been updated with templates for the Statewide Medicaid Managed Care (SMMC) – Managed Medical Assistance (MMA) Program managed by the State of Florida's Agency for Health Care Administration (AHCA).

AHCA relies on the Quest Analytics Suite™ to measure health plan network adequacy across all Florida counties by looking at geographic access and required provider minimums by specialty, making the Quest Analytics Suite the perfect tool for the job.

Client Profile

The Adequacy Analysis Module is best suited for health plans who currently offer Medicare Advantage networks or are planning a network expansion, as well as plans looking to get into these markets. This module already provides template-driven network adequacy measurements for hundreds of healthcare networks nationwide.

Examples: Medicare Advantage Plans, Part-D Pharmacy Networks, Medicaid Plans, Government Agencies, ...

As it has always been with Quest Analytics, you go out of your way to help with even the smallest of things thus making the client feel that they are more important than anything else.

Ron Ventura
Director of Reporting
Value Options