Adequacy keeps you compliant.
The plans growing margin
are playing a different game
Network sufficiency gets you licensed. Network intelligence gets you profitable.
Leading plans are using provider data to reshape how they compete, not just how they comply.
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~70%
Network overlap between competing plans
$2M+ saved
By identifying outlier hospital contracts
25%
Top MA plan's growth attributed to network strategy
25+ Payers
Trust HealthWorksAI for competitive intelligence
The Challenge
Network adequacy is a compliance floor. Margin requires more.
Most plans manage network to CMS standards. That tells you nothing about how competitors are deploying theirs — which specialists they’re locking in, which geographies they’re quietly abandoning, and which gaps they’re using to poach your members.
Health plans that only track adequacy aren’t falling behind on compliance. They’re falling behind on strategy.
The Solution
Three capabilities that shift network from reactive to strategic.
01
Competitive Network Benchmarking
Know where you stand. See how your network stacks up against every competitor in every county effortlessly.
Powered by NetworkIntel™
02
Physician Group Intelligence
Track shifting affiliations of physician groups, providers locked in by competitors, and risky referral patterns.
Powered by NetworkIntel™
03
Network-to-Enrollment Modeling
Quantify how specific network changes will affect enrollment projections. Move from intuition to real numbers.
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Not just a platform. A Network Strategy Partner.
Health plans don't always need another dashboard. Sometimes they need a team
that knows the data, understands the market, and can work alongside their network leaders
to solve a specific problem.
Competitive Network Audit
Identify where your network is undifferentiated, where competitors are locking in high-value providers, and where your gaps are creating enrollment risk.
Network Design for New Markets
Build a provider network for a new geography or population segment, from C-SNP to D-SNP, with adequacy checks built in from day one.
Outlier Provider Analysis
Find hospitals and groups that are driving cost without driving enrollment. One plan saved $2M+ by acting on two counties.
Contract Renegotiation Prep
Arm your contracting team with competitive benchmarks before hospital and group negotiations, timed to June and December renewal cycles.
How Teams Use It
From data to decision in a single workflow
Assess your current position
See if your network is genuinely differentiated or if 70% of your providers overlap with competitors.
Identify strategic opportunities
Surface providers with the highest competitive and enrollment impact.
Model the margin outcome
Connect network decisions to financial outcomes before committing resources.
"HealthWorksAI helped us identify a critical network gap in two target counties before our competitors noticed."
Common Questions
Medicare Advantage Network Strategy — FAQ
What is network strategy for Medicare Advantage health plans?
Medicare Advantage network strategy goes beyond CMS adequacy requirements. Rather than managing a network to compliance minimums, network strategy uses competitive intelligence to understand which providers competitors are locking in, which geographies they are abandoning, and how network composition directly drives enrollment and margin. HealthWorksAI's NetworkIntel™ delivers NPI-level benchmarking across every competing plan in every county.
How is NetworkIntel™ different from standard CMS network adequacy tools?
CMS adequacy tools tell you whether your network meets the minimum standard. NetworkIntel™ tells you how your network compares against every competitor at the NPI level — including specialist composition, physician group affiliations, and the ~70% provider overlap most competing plans share. Knowing where you overlap is the starting point for building a network that actually differentiates your plan.
Which teams use HealthWorksAI's network strategy intelligence?
Network strategy intelligence is used across VP of Network Strategy, contracting teams, CFOs, and growth leaders. Network teams use it for competitive audits and contract renegotiation prep. Finance teams use it to identify outlier hospitals driving cost without driving enrollment — one plan saved $2M+ by acting on two counties. Growth leaders use it to model how network changes impact enrollment projections before committing resources.
What results have health plans achieved with HealthWorksAI network strategy?
Plans using HealthWorksAI's network strategy intelligence have identified critical network gaps before competitors, saved $2M+ by addressing outlier hospital contracts in two counties, and attributed 25% of growth directly to network strategy decisions. More than 25 leading health plans trust HealthWorksAI for competitive network intelligence across Medicare Advantage markets.
See Your Network's Competitive Position
We’ll walk you through a live view using your actual market data.