National health plan increases competitive overlap to 70% for 900+ Medicare Advantage networks in under 12 months

Medicare Advantage is expected to reach 40% penetration by 2025. By 2023, available annual profit pools will range from $11 billion to $13 ­billion, making Medicare Advantage the single biggest driver of profit growth for health care insurance providers¹. For health plans looking to grow their share of this market, they need to ensure that they’re as competitive as possible.   

For one national health plan, the strategy to improve and expand their Medicare Advantage networks was built upon meeting competitive overlap targets. However, the data they utilized to evaluate competitor networks and inform their business decisions was incomplete and siloed, making it difficult to reach their aggressive growth goals. To solve this problem, they implemented Clarify’s Network Optimization Solution, an on-demand software that enabled them to instantly design new networks and optimize existing ones. Precise, case-mix adjusted provider performance benchmarks combined with competitive intelligence at the provider-level made the identification of key providers for each market seamless, allowing the plan to optimize or launch 900+ Medicare Advantage networks in under a year.

Read the full case study to learn more about their success.