This month, payer solution experts from Clarify hosted a webinar to discuss the challenges of and best practices for creating and managing high-performing provider networks. Read this recap and watch the recording to learn about the three capabilities that are transforming network design in the same way predictive analytics transformed online retail.
Tips from the webinar:

  1. Identify the optimal geographies to build a network based on the type of members the network will serve, across multidimensional performance factors including reimbursement rate intelligence, provider performance on quality, cost, and utilization, as well as market-specific demographics and composition.
  2. Understand existing provider referral patterns. It won’t do you any good to have all the best providers in your network if they don’t refer to each other. Capturing natural provider referral patterns and identifying top performers for patient-provider matching ahead of time will help you build your network smarter and reduce unnecessary and costly provider referrals in the future.
  3. Determine who should be in your network given the goals, your network design, or plan type. Effective modeling of how your network is going to perform and which tweaks might have a significant impact on your overall network will allow your organization to successfully build high-value networks. Advances in network building technology allow for dynamic scenario planning where administrators can easily manipulate case-mix adjusted data. This provides the precision necessary to make tough network decisions with confidence. Watch the recording to see this technology in action.

Clarify’s payer solutions are powered by a dataset representing 220+ million lives across Medicare, Medicaid, and commercial populations. We combine this rich dataset with best-in-class data science and machine learning techniques to create “Expected Values” for each patient-provider interaction across a vast library of metrics. For every provider, provider group, hospital, health system, and downstream provider, we calculate observed performance on any given metric and compare it to how they were expected to perform based on factors unique to that provider. This allows for fair comparisons across providers, incorporating over 300 different patient and clinical factors, from HCC risk scores to social behavioral determinants of health. By giving customers transparency into cost, quality and utilization, and provider referral patterns from day one, Clarify makes building a new provider network as easy as shopping online, all while ensuring that your members receive the high-value clinical care they need.

Learn more about our healthcare referrals solution today.

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