Provider network development. Strategy to execution.
Blakemore Consulting is a boutique, independently owned provider network development and network adequacy firm serving as a true extension of health plan leadership teams.
Turnkey network development, strategy through execution.
Blakemore Consulting is a turnkey provider network development firm with experience in over 35 states and 600+ counties. We lead the development, strategy, and execution of new network builds, network expansions, re-contracting efforts, network management, and network optimization, either owning the build outright or running it alongside your team.
We partner with national carriers, multi-state insurers, regional and provider sponsored plans, government focused organizations, and venture backed plans.
Health plans of all sizes, at every stage.
Regardless of scope, our focus remains consistent: speed, precision, and disciplined execution.
We have sat on your side of the table
Our contracting work was done inside health plans before it was done for them. We know how a build is evaluated internally: how far a rate can move and still clear finance, and what leadership needs from every department before a filing goes out.
We often know the market going in
Thirty-five states of build history means we often arrive already knowing the major systems in a market, how they negotiate, where the leverage sits, and what a defensible rate looks like. Speed to market comes from knowing the terrain, not from working faster.
No ramp period, staffed on day one
There is no ramp period, no hiring cycle, and no learning curve billed to you. The team that scopes the engagement is working the market the week it starts.
Your systems, your name, your data.
We built our operating model around the four things health plans say make external help harder than it should be: data leaving their environment, a second name appearing in front of their providers, status they only see at a meeting, and fees that fund coordination.
Your systems or ours
We work inside your environment: your VDI, your internal systems, your CRM, your contract management and reporting tools. Provider data stays inside your environment, under your access controls and your retention policy, rather than being copied to a vendor system.
Or we run the build in ours and hand everything over. There is no charge to access it or to extract from it, in any format, at any point. Analyst time for reporting is scoped in the SOW.
We work under your name
Outreach from an unfamiliar sender often does not reach the right desk. Outreach from the plan itself does, and it gets read.
Going to market under your name removes that friction. Our role is to strengthen your presence in the market, not insert another brand between you and your providers, and that relationship stays with the plan when the engagement ends.
Reporting you can see
You have direct visibility into the same contracting pipeline, adequacy position, and outreach history we work from.
Status is not assembled into a weekly or monthly summary and sent to you. You see the work as it happens, not a version of it prepared for a meeting.
One executive, full accountability
One executive owns the engagement end to end. Where a large build needs state or market leads, they work under that one executive, and every one of them is in the build.
Your fee covers a lean leadership model, without redundant roles layered across functions.
Comprehensive and integrated network solutions.
Network Strategy & Development
Speed to market through targeted provider contracting, what-if scenarios, network modeling, and target reprioritization.
Provider Recruiting & Contracting
Every provider type across the full continuum of care, from primary care and specialists to acute and outpatient facilities, post-acute, LTSS, behavioral health, and ancillary.
Network Adequacy & Support
Geo-mapping, time and distance standards, white space identification, and the submission itself through deficiency response.
Provider Data Management
One validated provider file, verified against national sources, supporting accurate adequacy reporting and directory submission.
Network Intelligence & Rate Benchmarking
Competitor rates, roster overlap, and network to network comparisons. Professional and facility rates benchmarked against a CMS Medicare baseline on federal transparency data.
Value-Based & Delegated Contracting
The full reimbursement spectrum, from fee-for-service through shared savings, shared risk, and full delegation.
Staff Augmentation & Interim Leadership
Experienced recruiters, negotiators, analysts, and network executives placed inside your structure, without a ramp period.
Credentialing
NCQA-certified CVO partnership, sequenced alongside contracting to keep credentialing from becoming a constraint on your launch date.
Adequacy risk surfaces early or it surfaces at filing.
Adequacy risk usually concentrates in a handful of counties and one or two specialties that nobody modeled until submission. We run the gap analysis first, so the at-risk counties get worked while there is still time to close them.
Internal planning tool. Used to model market viability and gap exposure before recruitment begins. Filing submissions are produced in Quest Analytics and J2 Health.
Specialty-by-county segmentation against the applicable standard before outreach begins.
County-level tracking through the build, so risk surfaces while it is still fixable.
Quest Analytics and J2 Health adequacy reporting, Letters of Intent, exception requests, and deficiency response.
Negotiated rates are public. Turning them into decisions is the work.
Federal price transparency rules require health plans and issuers to publish their negotiated rates. The files are public and effectively unusable without infrastructure built to handle them. We built ours, we own it, and it turns those disclosures into professional and facility rate positioning.
A single carrier's monthly disclosure runs to hundreds of gigabytes. A market comparison means ingesting several of them, every month, without sampling.
A published number may be a fee schedule amount, a percentage of charges, a per diem, or a case rate. Treating them as equivalent produces confident nonsense.
Files carry rates for providers who do not deliver the service, or are not really in the network. Left in, they move every median.
Rates attach to NPIs and TINs, not to organizations. Rolling them up to the health system a buyer actually negotiates with is its own resolution problem.
This is the work behind the analysis. It is proprietary infrastructure we built and maintain, not a licensed dataset or a vendor tool.
Professional and facility rates by plan, each expressed against its own Medicare basis.
Percent of the applicable Medicare basis. Illustrative figures shown. Actual positioning is market-specific.
Overlap tells you which providers each network actually has, and which it does not. That is the input to competitive positioning, a recruitment target list, and a disruption analysis when members move between products.
Illustrative figures shown. Actual analysis produces provider-level detail with NPI mapping and system-level rollup.
Federal Transparency in Coverage files pulled directly from each carrier's public disclosure, processed with automated quality controls.
Professional rates normalized to the CMS Physician Fee Schedule with GPCI adjustment. Facility rates normalized to IPPS and OPPS with wage index adjustment, so a hospital in one market is comparable to a hospital in another.
Ghost rate detection, rate-type segregation, minimum sample thresholds, and outlier resolution applied at the pipeline level.
NPI-level identification with taxonomy classification for practitioners. Facilities resolved through Type 2 organizational NPIs and CCN cross-reference, so hospital rates attach to the right system.
Delivered as a complete deliverable with a supporting workbook, not self-serve software.
Network build highlights.
30+ network builds delivered across 35+ states and hundreds of counties, spanning all lines of business.
Medicare Advantage expansion, five markets
Scaled a foundational Medicare Advantage provider network across five priority expansion markets, adding ~10,000 providers and supporting six-figure membership growth across two Annual Enrollment Periods.
Statewide Medicaid procurement, first-time market entrant
Delivered the statewide Medicaid provider network behind a competitive procurement for a plan entering the state for the first time. Selected over incumbent bidders, launching statewide across Medicaid and the dual-eligible population on a single integrated network.
QHP new market entrance
Assembled and stood up the provider network for a health plan's first Individual Marketplace entry in the state, achieving state and federal adequacy and closing anchor health systems in a market with established competitor alignments.
First proprietary employer network for an emerging insurer
Built an emerging insurer's first proprietary group health network for its inaugural market entry. Contracted from a standing start, with no claims history or existing provider relationships to negotiate against, anchored by a major regional health system and built to QHP adequacy standards for small to medium sized employer groups.
ACO REACH two-sided risk contracting
Accelerated contracting for a risk-bearing Medicare ACO, closing 15+ primary care agreements over a 21-day sprint and enabling ~5,000 newly attributed beneficiaries ahead of the CMS deadline.
Multi-state contract consolidation
Consolidated and optimized a fragmented portfolio of 175+ payer contracts across 25+ states for a PE-backed multi-state provider group, standardizing fee schedules and reimbursement structures. Contributed to a multi-hundred-million-dollar strategic acquisition.
Tell us what you are building.
Market, line of business, and the filing or launch date you are working toward.
We walk the county list, the adequacy standard, and what the build actually requires.
Staffing, sequencing, and timeline built to your filing date, with pricing to match.
All staff are United States based. No functions are performed offshore.
Provider network development, network adequacy, and rate intelligence for health plans and risk-bearing organizations. Independently owned. All staff United States based.
Wimberley, Texas