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Case Studies

CHALLENGES SOLVED, LESSONS LEARNED

Outgrown Homegrown System

This MCO faced unique challenges in efficiently assessing and ensuring network adequacy and provider data accuracy for its Medicaid program.
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Working Smarter, Not Harder

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.
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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.
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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.
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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.
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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.
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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.
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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.
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“Are We Compliant — or Not?”

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

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