QES Competitive Insights is a valuable tool for data-driven decision-making, helping you quickly build successful networks and understand the competitive landscape before you venture into new markets. Learn how Quest Analytics® clients are already putting QES Competitive Insights into practice to address common issues.
See how your potential network stacks up against the competitors already in that market
Scenario: You’re building a new network and wonder: How does your potential network stack up against the competitors already in that market?
How QES Competitive Insights can help: With this new tool, you’ll get a snapshot of all the players competing in a particular service area, with key statistics about those networks. For example: membership size, market share, Centers for Medicare & Medicaid Services (CMS) Star Rating, and whether they are an HMO or PPO network.
From there, you can select networks of interest for your competitive analysis and then dive into additional details, such as the number of hospitals and providers by specialty in each network. Using claims intelligence, QES Competitive Insights can also show you the average effectiveness and quality scores of one network versus another. You can also see how many ghost providers you have in your network and how that compares to your competitors, revealing potential red flags before you ever get to market.
The tool can also provide insights on network overlap, such as which providers are unique to your network, which ones your competitors have that you don’t, and which providers are common across networks. This can help you optimize your market position before you launch.
Decide if market expansion is your right move
Scenario: You’re trying to decide if expansion is the right move.
How QES Competitive Insights can help: Before expanding into a new market, it’s essential to understand the competitive dynamics in that region. QES Competitive Insights provides valuable intelligence on who the competitors are and what it would take to build a competitive provider network in that area. You can assess the potential revenue for the market and whether there is any overlap with your existing networks. This helps you evaluate the potential “lift” required for expansion so you can make smart growth decisions.
identify providers for contracting
Scenario: You want to identify providers for contracting.
How QES Competitive Insights can help: Understanding how providers align with your strategy and their relationships with competitor plans can be critical for building a network. With QES Competitive Insights, you can quickly identify a prospect list for recruitment, exploring where your network has gaps compared to competitors and where you might develop an advantage.
For example, let’s say you want to identify the providers that have high effectiveness and efficiency scores. QES Competitive Insights can pull that list, helping you zero in on high-performing, active providers who are in your competitors’ networks but not yet in yours. You can then leverage this list to focus on contracting with these providers, accelerating the development of a more competitive network. Additionally, you can use the provider lists to model different scenarios, further optimizing your new network.
Sharpen your network's competitive edge
Scenario: You want to sharpen your competitive edge.
How QES Competitive Insights can help: To maximize your health plan’s success, you must build and expand your healthcare network to attract target employers and members while partnering with top-tier providers, ensuring that your plan is optimally positioned to serve your member population. With QES Competitive Insights, you can differentiate your network to better understand market needs and gaps. You can also consider the cost, quality, and payer mix when prioritizing providers for contracting.
Outpace with QES Competitive Insights
Staying ahead requires actionable insights. Quest Enterprise Services® (QES®) Competitive Insights offers a strategic advantage by providing industry-trusted data to optimize network performance, enabling comparative analysis, gap identification, and informed decision-making while aligning network design with market dynamics. Enhance member access, satisfaction, and care quality. Schedule a complimentary consultation to learn more today.
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.
