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.

Key Features

  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.

Industry-Leading Data

Medicare FFS Claims Table

Build Better Networks

Build high performing networks by using market profiles that capture physician (primary and specialty), practice group, and facility (inpatient and postacute) performance with patient population trends to find and include the right providers in your network. Simulate the impact of different combinations of providers on total network performance.

Network Advantage Build Better Networks

Benchmark Providers

Benchmark providers against their peers and networks for any given market by exploring cost, quality, and care model performance over time.

Network Advantage Benchmark Providers

Optimize Operations & Grow Market Share

Understand referral patterns by calculating market share by region (CBSA) or service line (MDC), helping identify competitor trends and drill down on provider-level referral volumes.

Network Advantage Optimize Operations

Understand Bundle Performance by Network, Rendering Provider, and Facility

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

Network Advantage Bundle Performance

Facility Profiles

Network Advantage provides detailed hospital profiles that show where admissions are coming from, the results of their stay, and where discharges go to. For discharges to any post acute setting, users can further drill into the effectiveness of those facilities and agencies in managing recovery and reducing downstream cost.

Network Advantage Facility Profile Dash