Quest Enterprise Services

PROVIDER NETWORK ADEQUACY EVOLVED

Provider network adequacy analysis with a composite score of 61.6.

BRING NETWORK ADEQUACY TO YOUR ENTIRE ORGANIZATION

Quest Enterprise Services (QES) Adequacy solution provides your organization with the tools you need to easily measure, manage and monitor your network performance. Your team can see the status of your provider data and how that affects the adequacy of your network. With this type of visibility, cross-team communication, network transparency, and compliance monitoring processes will be streamlined and help you differentiate your network. It goes beyond adequate networks to excellent member experiences and a more competitive network overall.

Provider network adequacy analysis.

FULL-SPECTRUM ADEQUACY ANALYSIS

At the core of our solution is the Adequacy Analysis. QES starts with the time and distance analysis, used by The Centers for Medicare and Medicaid (CMS) and other regulators, and takes that to the next level with a full-spectrum view of your network through aggregate scoring, trending and comparisons over time.

Our summary dashboard is an invaluable tool, providing an overview of all the networks you manage. QES includes an aggregate adequacy score and allows modeling of your network to demonstrate what happens when providers are added and removed over time. Take your network analysis one step further and compare your network against current market providers to understand the depth of your network. View the gaps in your network, their age, and how they have changed daily, weekly or monthly.

FIND NEW OPPORTUNITIES TO EXPAND AND KNOW WHO TO RECRUIT

We get it – expansion efforts generally take a mountain of research and Herculean efforts to come to fruition. With the Adequacy solution, you can easily project and validate the next best counties to expand your plan. It can show you exactly how the expansion will affect your overall network adequacy and the effort that it will take.

The QES Adequacy solution provides you with smart recruiting, saving you time and resources. Easily run what-if scenarios to project adequacy when you target providers from your network data and market data. And discover providers who can fill adequacy gaps across your networks.

Drive Workflow Efficiency in QES Adequacy 

Our enhanced toolset for the QES Adequacy solution focuses squarely on helping you improve your organization’s workflow, saving your team time and resources by making complex tasks easier. QES workflow enhancements include:

Bulk Actions: Terminations

Easily run termination analyses across multiple plans and geographies by uploading a list of NPIs or TINs. Model the impact of removing a group of providers and see the impact on your network adequacy in real-time — taking the “work” out of managing large quantities of data and doing things in the aggregate.

Provider network adequacy assessments with composite scores.

Membership Add-On

Analyze network adequacy with your member distribution data to assess the members at risk in a gap area. Compare your data to the population distribution or assign member demographic data by specialty. QES also includes a sample population allowing you to understand gaps in future expansion areas where you may not have membership distribution.

Exceptions Add-On

Expedite reports and enhance exception narratives. Zip Code Summary Reports provide results within a county at the zip code level, and Next Closest Provider Reports show a list of providers outside of the requirements that fulfill the organization’s “next closest provider” requirements. This feature helps regulators better understand your requested exceptions.

More Than Meets the ROI

More Than Meets The ROI

Case study – For Dee Bellanti at HealthNow New York Inc., smarter provider network management was a better investment than they imagined. This case study explores how a costly CMS penalty proved managing their provider networks the same old way simply wasn’t good business.

Deliver on tomorrow’s goals by planning today

We are committed to assisting our customers in their quest for accurate provider directories and adequate health networks that maintain appropriate access to care for your members.

Schedule a consultative session with one of our network management experts to discuss and determine your strategy.

Book a Strategy Session