Building a High-Performing Specialist Network For a New Medicare Advantage Plan

Our member is a non-profit organization that is nationally recognized for providing innovative, high-quality health care coverage to over a million members across Medicare Advantage, Medicaid, and commercial plans.

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Our member started a Medicare Advantage offering in a new market in late 2018, and throughout early 2019, focused on developing a network with strong primary care offerings. They needed the ability to view and select high-performing Specialist providers to participate in this new Medicare Advantage plan. What they lacked was access to sufficient data to support informed decision-making.

How CareJourney Helped

CareJourney’s data and platform have been instrumental for this member in making decisions about which specialist groups to approach for contracting conversations. Specifically, CareJourney provided utilization patterns and referral views to understand which Specialists were already being utilized heavily by existing in-network primary care providers.

The Specialists were further evaluated using provider and practice group-level performance metrics, such as CareJourney’s cost and outcomes provider performance index scores. For instance, CareJourney analysis enabled the member to identify a particular medical group receiving a high volume of out of network cardiology referrals, and profile the medical group’s providers to identify areas of strength and opportunities for improvement.


Over the course of the past year, CareJourney has built a strong relationship with this organization, meeting bi-weekly to ensure product fluency and monitor progress towards goals. As the new network has grown, CareJourney has ingested the updated list of providers into our products to allow the health plan to continuously monitor the network’s performance and reach. The organization has been highly anticipating the newly released provider performance scorecard, which details provider performance on individual episodes of care, and will provide the organization with the detailed data needed to have productive, informed contracting conversations.

In addition to this growing new network, the health plan has used CareJourney’s offerings and analytic guidance for performance management in their established networks. For example, they have ingested the CareJourney cost and outcomes index scores into their internal performance tracking systems, and used these measures to benchmark performance for a major practice group against the broader network to identify areas for improvement.

1M+ Members

“CareJourney’s analytics have allowed us to identify high-performing providers who would be an asset to our growing health plan.”