Sub-Category: Regional Health Plan

Growing Nowhere Fast

A car stuck in a flock of sheep on a rural road, unable to drive

The Situation One of the nation’s largest not-for-profit health plans saw a significant opportunity to expand into new counties and new states. But like many plans in their position, their ability to build adequate networks with any degree of efficiency fell far short of their ambitions — a fact quickly discovered by the network manager… Read more »

Uniting an Enterprise

Close-up of polished gears meshing perfectly inside a machine

The Situation When you’re one of the nation’s largest health insurers, meeting CMS adequacy requirements for your Medicare Advantage networks can be challenge enough. But when you’re also managing large Medicaid networks in multiple states, each with its own set of adequacy rules, the job can quickly overwhelm. “There really wasn’t a mechanism to analyze… Read more »