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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Key Stakeholders
- Executive leadership
- Strategy heads
- Provider network leaders
Our Approach
- Provided insights from approximately 1TB of provider and plan information within a mere 2 weeks.
- Saved the client an estimated 8 months of manual labor.
- Facilitated filtering by plan category, county, product, and Star rating.
- Incorporated exclusive adequacy and alignment scoring across networks.
- Offered tailored download reports to aid team-level processes.
Business Impact
- Achieved 90% faster insight delivery vs. internal teams (2 weeks vs. 8 man-months).
- Analyzed 400+ plan-networks, 200+ networks, across 40+ markets.
- Eliminated analyst hours for NPI-based contracting lists.
- Identified 25+ counties for expansion and 15+ networks for optimization.
- Pinpointed top competitor providers across markets.
- Enabled 48-hour turnaround for new market additions.
- Ensured always-current intelligence with quarterly updates.
Continuous Insights
- Consistent Competitive Intelligence: Quarterly data refreshes ensure ongoing strategic relevance.
- Collaboration-Enabled Platform: Teams can annotate, assign tasks, and monitor progress within NetworkIntel™.
- Rapid Expansion Facility: New markets can be incorporated within 48 hours for swift adaptability.
- Improved Group-Level Perspectives: Facilitates group-level network analysis, allowing for more accurate contracting choices.
