Network Advantage: Build and Optimize Networks of Care

By unlocking the power of Medicare’s full claims dataset, CareJourney provides robust insights into provider and facility performance, measured by patient-centric, clinically-relevant metrics without the need for any client data.

Actionable Insights


  • All CMS Medicare Part A and B claims data for the past eight years, updated quarterly through Q4 2018, Part D data from 2011 – 2017, Medicare Advantage Part C data for 2015
  • Claim-line level detail on 65M Medicare and Medicare Advantage lives
  • Ability to develop linkages across patient care journeys for longitudinal analytics insights on cohorts
  • One of few CMS innovators with a commercial license

Data Science

  • Extensive claims data science experience behind our recommendations and algorithms, built on open data and algorithms for no black boxes
Analytics Platform

Analytics Platform

  • Cloud-based, scalable and secure data warehouse
  • Customized to members’ network structures
  • Fully interactive point and click user interface
Customer Support

Customer Support

  • Member services team as a champion for member success, providing product and data interpretation support and fielding feedback for product enhancements
Network Advantage Difference

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