A National Payer’s Smarter Network Strategy Across 40+ Markets Using NetworkIntel™

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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