Case Study
A National Payer’s Smarter Network Strategy Across 40+ Markets Using NetworkIntel™
Inside the 2-Week Race to Analyze 68 Networks Across 36 Markets
Summary
A national Medicare Advantage (MA) insurer with more than 3 million MA lives faced the challenge of assessing its network’s competitiveness over a vast and varied territory, encompassing more than 200 networks across over 40 markets and 400+ plans. The goal was straightforward: swiftly and precisely pinpoint opportunities, risks, and discrepancies within its D-SNP and Non-SNP provider networks.
Instead of relying on scattered spreadsheets and manual labor, the insurer collaborated with HealthWorksAI to leverage the Provider Network Comparison dashboard offered by NetworkIntel for a comprehensive, multi-network competitive benchmarking effort.
The Business Challenge
The leadership team needed a way to:
- Quickly evaluate where their networks were either insufficient or excessively developed relative to leading competitors.
- Determine which providers were crucial for adequacy, member preferences, and strategic alignment.
- Facilitate informed contracting choices with data-supported assurance—without dedicating months to analysis.
Their current internal tools and resources couldn’t accommodate the complexity or scale of this initiative.
The NetworkIntel™ Solution
1-to-Many Network Benchmarking Designed for Decision-Making
Using NetworkIntel™’s benchmarking capabilities, the team executed a 1-to-many network comparison analysis against leading competitors across more than 40 markets. This enabled them to:
- Quickly identify NPIs present in all top-performing networks, indicating critical or compliance-essential providers.
- Detect network deficiencies, redundancies, and anomalies by plan category, county/state, and Star rating level.
- Assess network scope and strategic depth instantaneously—without developing their own internal comparison framework.
Beyond The Scope of Output
Executive-Level Insight:
Summary KPIs, the exclusive Network Score, and easily digestible dashboards assisted leaders in prioritizing:
- Markets with quick growth potential.
- Networks needing immediate focus by product category
- Choices between expansion and rationalization.
Granular-Level Data:
NPI-level provider lists equipped contracting teams to undertake specific actions:
- End or renegotiate agreements with redundant or underperforming providers.
- Concentrate on impactful additions to match leading competitor networks.
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