Optimizing health plan performance requires a deep understanding of competitive positioning. The Becker’s Healthcare Podcast episode, “Benchmarking for Better Networks: Optimizing Health Plan Performance,” featured Quest Analytics® leaders, Subhash Seelam, Senior Vice President of Applied Network Analytics, and Bob Tavernier, Solutions Executive, discussing the importance of network benchmarking. Their discussion provided a roadmap for health plans aiming to enhance performance, patient outcomes, and profitability.
The Importance of Network Benchmarking in Healthcare
The episode dives into network benchmarking, highlighting its critical role beyond mere data comparison. Seelam and Tavernier emphasized that benchmarking is not merely about comparing data but understanding the network’s operational nuances. By benchmarking effectively, health plans can identify areas that need improvement and optimize their operations to stay competitive. Benchmarking allows health plans and payers to quantify success rates across various metrics.
Key Metrics in Network Benchmarking
Effective benchmarking compares the payers or plans against three main metrics: their past performance, current competitors, and market medians. A lack of growth against historic performance may indicate faulty protocols or staffing issues.
Types of Benchmarking: Internal vs. External
Benchmarking can take two forms: internal and external.
Internal Benchmarking uses past performance data to measure current results. It provides a baseline that helps identify trends and gaps within the organization.
External benchmarking, like Quest Enterprise Services® Network Benchmarking, uses third-party data to measure performance against market standards and competitor data. This broader view helps health plans gain a holistic picture of their positioning in the market.
Six Broad Areas of Network Benchmarking
Seelam outlines the six broad areas where benchmarking is beneficial.
- Clinical Outcomes: Measuring care and service, including quality measures and patient safety. They also include population health management or management of chronic conditions, preventative care, and early detection.
- Utilization: Evaluating resource management and service management, such as the number of tests needed for accurate diagnosis and average stay duration per diagnosis.
- Cost Management: Determining the medical loss ratio and medical expenses to determine the total cost of care.
- Member Satisfaction: Tracking member retention and member satisfaction scores, which can also impact CMS ratings and payments.
- Operational Efficiencies: Assessing the timeliness of care, processing efficiencies, and other functional performance statistics.
- Regulatory Compliance: Ensuring health plans meet state and federal regulatory standards.
Applying Network Benchmarking Data
Tavernier outlines several ways to utilize this data effectively. Analyzing the performance of physicians and facilities can establish a baseline for rate adjustments, negotiations, and contract renewals. It also aids in creating vendor and provider contracts based on performance guarantees, such as pay-for-performance models.
Beyond optimizing cost performance within the system, benchmarking data can distinguish a health plan from its competitors. Achieving NCQA accreditation and focusing on population health and health equity initiatives help set quality of care standards and serve as benchmarks for regulators, establishing the core efficiencies expected of health payers.
Detailed data analysis identifies gaps in protocols, helping to eliminate costly procedures, reduce readmissions after surgery, and curb excessive spending. Ultimately, this data allows for the direction of patients to higher-performing clinicians, leading to better healthcare decisions.
The Advantages of Third-Party Network Benchmarking
Internal benchmarking is essential for organizations to assess their growth or stagnation. However, it has its limitations.
According to Tavernier, third-party vendors are better equipped to provide a comprehensive view of both individual health plans and the broader market. They possess data infrastructures and a skilled talent pool dedicated to continuous data collection and analysis. For these reasons, external benchmarking can quickly spot patterns and help organizations lead to better strategic decisions.
Furthermore, integrating network data with claims data yields more precise and insightful analysis than relying solely on claims counts.
Making Health Plan Efficiency with Completive Network Benchmarking
Network benchmarking is an indispensable tool for health plan optimization. However, its complexity necessitates a combined internal and external approach to truly realize its benefits. Quest Analytics Network Benchmarking offers indispensable expertise and comprehensive data, providing a clearer, more actionable picture of where health plans can improve and achieve competitive differentiation. By leveraging these resources, health plans can navigate the complexities of an ever-evolving marketplace with greater confidence and success.
Find More on Network Performance
Proven Solutions for Your Provider Network Management
Looking to simplify your workload? Let Quest Analytics take on the heavy lifting! Our solutions and dedicated team specialize in provider data accuracy and provider network adequacy for various lines of businesses, including Medicare Advantage, Medicaid and Commercial. Schedule a strategy session today and see how we can help you every step of the way.
