Why is building a network so challenging?
There are 6 core reasons: provider group and hospital consolidation, changing government regulations, fast-moving competitors, scattered information sources, new market unknowns, and fixed resources for variable needs.
Providers have more contracting leverage:
The share of primary care physicians affiliated with vertically integrated health systems increased from 38 percent to 49 percent from 2016 to 2018.1— Health Affairs
As such, it’s increasingly difficult to aggregate provider data into an integrated, leverageable profile. Not to mention the other 5 factors.
This playbook identifies a prescriptive 3-step process for a successful network build, and offers an overview of the Zelis Network Builder & Optimizer capabilities.
1 Furukawa, M.F, Kimmey, L., Jones, D.J., Machta, R.M., Guo, J., & E.C. Consolidation Of Providers Into Health Systems Increased Substantially, 2016–18. Health Affairs, Vol 38. No. 8. https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00017