Emerging Health Plan Simulates and Optimizes Network Performance

Our member is an emerging regional payer centered around serving the senior population. They aim to disrupt the Medicare Advantage market by leveraging data analytics to make better, more efficient decisions about care.

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Challenges

In order to grow its network, this organization entered a partnership with a large health system encompassing several thousand affiliated physicians. This presented an expansive opportunity to grow their value-based contracts.

Both organizational teams aligned on a pilot program with a primary care practice group to determine their readiness and assess this health system’s performance in the context of a value-based contract. As the organization worked on expanding its network, it needed access to relevant data on providers and systems outside of who they already partnered with. While anecdotal examples were helpful, sufficient data anchored in real results to make informed decisions was missing

How CareJourney Helped

Partnering with CareJourney, this organization was able to access claim level detail on the health system’s primary care physicians, and evaluate their performance over the last eight years. Additionally, CareJourney applied clinically relevant metrics and open-sourced methodologies to provide the organization with specific insights in how these providers would perform in a value-based contract.

The organization was able to simulate a network of providers in order to select the top-performing practice group for this pilot program, including sharing this data with the health system.

Impact

Using CareJourney’s network simulation, market overview, and provider performance index solutions, the organization was able to identify practices optimized for success in value-based contracts and secure the right partnership to expand their market.

Moving forward, they will continue to monitor the progress with frequent data and insight updates from CareJourney, and expand partnerships to other high performing providers at the Health System.

8 Years
Historical
Performance
Evaluation

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Using CareJourney’s network simulation, market overview, and provider performance index solutions, the organization was able to identify practices optimized for success in value-based contracts and secure the right partnership to expand their market.