Insights for Payers
May 26, 2023
A large, global health insurance company has a Centers of Excellence (COE) program that annually evaluates its network hospitals on patient outcomes and cost efficiency. In years prior to 2020, the COE program used State-based All-Payer Claims Databases (APCDs) to calculate its ratings. However, the data was not current, coverage varied, and it was cumbersome and time consuming to produce benchmarks. They selected Clarify Networks, a network design and management software that includes precise, case-mix adjusted provider performance benchmarks to use for their annual evaluation. As a result, they strengthened the value of their COE designation, improved patient outcomes, and increased member retention.
“By switching from All-Payer Claims Databases to Clarify Networks we now have significantly more precise measurement of hospital performance and a fairer comparison of hospitals serving widely different patient populations which has strengthened the value of our COE designation.” Vice President, Network Analytics
