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.
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02
Physician Group Intelligence
Track shifting affiliations of physician groups, providers locked in by competitors, and risky referral patterns.
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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."
See Your Network's Competitive Position
We’ll walk you through a live view using your actual market data.