Network Advantage: Build and Optimize Networks of Care

Network Advantage is a market intelligence tool powered by our approved license to access CMS’s full Medicare, Medicare Advantage, and Medicaid claims datasets – linked claims and encounters data for over 130 million beneficiaries with data updated on as frequently as a quarterly basis – that helps members evaluate and benchmark PCPs, specialists, and facilities across the US and build networks based on pre-selected and customizable performance metrics. By unlocking the power of publicly available claims datasets, CareJourney provides robust insights without the need for any member data.

  1. Understand Market Penetration and Wallet Share: explore network affiliations, geographic concentrations of patient activity, and facility share of wallet trends. Identify potential providers to add to your existing or new network, based on your own criteria.
  2. Dive into CBSA-level Provider Benchmarks: benchmark physician/specialist, physician group, and health system across the country or specific region based on patient-centric metrics like cost efficiency and outcomes.
  3. Optimize Network Operations: understand utilization patterns, bundles performance, and track referral patterns to optimize your networks or to improve performance.
Medicare FFS Claims Table

Provider Profiling and Network Design in Your Region or Across the Country

Network Advantage helps identify potential providers to add to an existing or proposed network based on user-defined criteria.

Network Advantage Provider Profiling and Network Design

Create networks that meet your conditions for:

  • Total lives managed
  • Risk-adjusted average and total cost
  • Specialist/Facility/PCP alignment
  • Care Model care compliance and savings opportunity
  • Part D Drug opportunity and utilization
  • Aggregate quality of care
  • Avoidable and unnecessary spend

Benchmark, Simulate Providers and Networks Against Their Peers

Network Advantage customers can benchmark provider and mock network performance across the country or region on patient-centric metrics.

Network Advantage
Network Advantage

Understand a Network’s Market Penetration and Utilization Patterns

For any given market, explore network affiliations, geographic concentrations of patient activity, and facility share of wallet trends.

Network Affiliated Fraction of Patients in a Selected Market
Network Advantage ACO Market Map
  • Look at overall network affiliated fraction of patients in a state, across counties and/or years
  • Zoom-in on a specific network, understand their footprint and market utilization by provider and facility, Y/Y
Sample Network Footprint and Spend Breakdown by Provider/Facility
Network Advantage ACO Market Utilization

Understand Bundles Performance by Network and Trigger Facility

Investigate trends in episodes of care based on Medicare BPCI logic for a particular network or facility with benchmarks and annual trends.

Average BPCI Episode Spend & Mortality Rate by Networks vs by Trigger Facilities
Select multiple networks to compare their average episode paid amount on a selected bundle to peers.
Filter on state and county to understand the distribution of average episode paid amounts for a bundle by trigger facility Y/Y; identify high-cost trigger facilities across networks.

Specialist Dashboards

Summary dashboards track and benchmark specialty spend activity in a given market and identify individual outliers, service mix, and more

Specialist Dashboards

Provider Profile Lists

Customizable profile lists allow users to select from dozens of specialty-specific measures to profile each doctor beyond just spend

Facility Profiles

Investigate sources of admissions and for discharges, length of stay, readmission rate, 30-day cost of care and much more for your and your competitors’ hospitals.

Network Advantage Facility Profiles Breakdowns

Interested in Learning More?

Schedule a Demo