Business Challenge
In October last year, a major national competitor launched around 100 new C-SNP plans across 42 geographies for AEP2025.
Our client, a national Medicare Advantage payer quickly recognized a strategic gap and market opportunity—but time was against them. The CMS deadline for new plan submissions was just around the corner: first week of February.
The leadership team needed to urgently understand:
- What drove the competitor’s rapid C-SNP expansion.
- How the C-SNP networks differed from their non-SNP counterparts.
- What changes were required in our client’s own network strategy across 36 markets and 70+ plans
Without quick, high-confidence insight, the opportunity—and CMS submission window—would be lost.
What NetworkIntel™ Helped Them Uncover
HealthWorksAI partnered with the client to deliver:
- Side-by-side analysis of the competitor’s C-SNP vs. non-SNP networks to decode the strategic network shifts.
- Nationwide benchmarking across 68 networks covering 36 markets—pinpointing where new contracting, realignment, or expansion was necessary.
- Strategic summaries comparing market-specific provider coverage, strengths, and gaps.
- Granular NPI-level insights highlighting providers to target for new contracts, terminations, or renegotiations to build stronger C-SNP offerings.
This was made possible by NetworkIntel™’s trusted foundation of harmonized, high-accuracy competitive data—— with over 76% of provider data sourced directly from payers.
How NetworkIntel™ Did It
With CMS deadlines looming, time was the biggest risk.
- The HealthWorksAI team delivered the full analysis in under 2 weeks—a process that would have taken the internal team up to 4 months.
- Powered by NetworkIntel™’s clean, comprehensive, and directly sourced national provider data, the client avoided pitfalls common in low-fidelity competitive datasets.
- The team received:
- Executive summaries to support fast decision-making.
- Actionable contracting lists to align market execution with strategic intent.
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