Case Studies

CHALLENGES SOLVED, LESSONS LEARNED

The Sales team at a Top 10 National Payer needed to stand out from their competitors when responding to Employer Group Benefits RFPs. To do so, quickly generating network access reports was critical for strong RFP responses.

Health Systems

Health System

The Best Offense Wins

Their team was looking for automated and integrated tools and insights that would allow them to better communicate the value of their Integrated Delivery Network, by specialty, with an end goal of improving their position during contract negotiations.

Provider Directory Accuracy

State Health Plan

More Than Meets the ROI

A costly CMS penalty proved they couldn’t keep managing their provider networks the same old way. For a New York health plan, smarter provider network management was a better investment than they imagined.

Service Area Expansion

Regional Health Plan

Growing Nowhere Fast

To quickly expand multiple lines of business into new counties and states, the health plan needed a faster, easier, and more cost-effective way to build adequate networks.

Service Area Expansion

State Health Plan

A Tale of Two Networks

Having struggled to build a Medicaid network, they now faced the more complex requirements of Medicare — with only one shot to get it right.

Regulatory Oversight

State Insurance Department

Oversight, Meet Insight

They had manual oversight of provider network adequacy—but zero insight into provider availability, provider data accuracy or performance across health plans.

Provider Directory Accuracy

National Health Plan

Too Bad to Ignore, Too Big to Fix

Provider data accuracy issues could have jeopardized their partner relationships — but they didn’t have an effective way to address them.

Network Adequacy

Metro Health Plan

“Are We Compliant — or Not?”

They had no effective way to find their own adequacy gaps — but CMS and state regulators were finding plenty

Enterprise Workflow

Regional Health Plan

Uniting an Enterprise

Struggling to meet the diverse adequacy requirements of CMS and states, the plan needed a smarter way to work.

Service Area Expansion

County Health System Plan

Building Their Own HMO

Wanting to set up their own HMO, they needed to build a county-wide Medicare Advantage network — with no previous experience managing CMS network adequacy requirements

TAKE THE FIRST STEP FROM ADEQUATE TO EXCELLENT

We partner with 95 percent of America’s health plans and have experienced the challenges of provider network design, optimization and management. We’ve built our platform by working side-by-side with you and working closely with CMS and more than 30 state regulatory agencies, independent review organizations and brokers. We know what the regulators are looking for and what tools your organization needs to build differentiated and excellent provider networks and member experiences. Contact us today and book a strategy session.

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