Design High-Performing Networks

Identify top performing providers to design and manage networks, maximizing value, and high-quality patient care

Results

Design higher performing networks

Network Performance Optimization

Identify the optimal geographies and the highest value providers to create high-quality, high-value networks

The Challenge:

Health plans often lack the necessary insights on provider performance to build high performing networks. Today they rely on a thin slice of market data and benchmarking methodologies that only compare to “average” performance. This results in an inadequate picture of provider performance on the quality and efficiency metrics that matter.

Our Approach:

Clarify helps payers identify which geographies are most attractive for expansion, enables the design of high-value networks, and provides insights into provider performance across cost, quality, and utilization.

Our Solution:

Market Explorer

  • Comparison and ranking of geographies based on customizable criteria, including clinical, utilization, quality, and cost-efficiency metrics and competitor market share
  • Performance scores and market intelligence by geography

Network Designer

  • Evaluation of providers in a market based on cost, utilization, and quality measures (e.g., HEDIS, STARS)
  • “What-if” scenario analysis across multiple variables to model potential impact of network design decisions on cost and quality
  • Referral Strength

Provider Insights

  • Detailed, customizable, provider scorecards with market-leading case-mix adjustment that enables comparison across physicians with different patient populations
  • Insight into provider payment rates across markets

Our Impact:

Understand market dynamics at a granular level
Enable visibility into market demographics, spread of reimbursement rates, and which providers have the greatest market share for specific types of patients

Enable top-line revenue growth through successful new market expansion
Approach new markets with certainty and rigor and dramatically reduce the time needed to establish and refine an optimal network and enable new market growth

Capture cost savings and increase high-quality care
Decrease spend on low-quality care and improve clinical outcomes by ensuring members receive efficient, high-value care

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The Clarify Care Optimization Platform

Actionable Analytics

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Care
Navigation

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Patient Guidance

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Program Administration

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