Network Development
The Problem
Continuous changes in the industry often cause organizations costly product delays and inefficient provider contracting fulfillment. Blakemore Consulting supplies our clients with strategic and flexible network development efforts to fully capitalize on financial opportunities as they present themselves in the marketplace.
Our Solutions
Overcome Your Limitation
Our clients overcome limited network development staff and restricted budgets to successfully place focused product initiatives.
Get Access to Our Experience
Our clients benefit from Blakemore Consulting’s long- standing provider relationships, calculated contracting approaches, experienced negotiating skills, strong knowledge of reimbursement methodologies, and market insights.
Extend in-House Capabilities
Our clients utilize Blakemore Consulting’s experience across a full continuum of managed care product lines to extend their in-house network development teams.
Network Development Strategy
Blakemore Consulting gathers and implements fundamental network development tools to initiate the project planning process for all targeted markets. At the center of our project management and reporting approach is our state/market specific dashboard. The dashboard provides key system and hospital understanding, statewide and county level adequacy, and county and specialty level recruitment detail which assists in monitoring contracting progress, and proactively identifying potential contracting risks. This proactive approach in monitoring progress and identifying potential risks allows us to assess and redirect our contracting strategy including adjusting timelines, as needed.
Targeted provider prioritization across multiple markets begins with key System / Hospital /PHO / IPA opportunities with the greatest impact to overall network adequacy. Acquisition of System/Hospital/PHO/IPA roster information allows our team to “pressure test” adequacy impact and proceed with independent provider contracting (aka “gap fill”). Of which, the team evaluates independent provider options and further prioritizes based on the number of “gap fill” opportunities within a given specialty type. This strategy allows us the opportunity to build and pivot with the strategic plan as needed to establish and re-establish targets as needed for adequacy.
Provider outreach is driven by the targeted provider’s overall impact to the expansion effort, the number of provider options available to satisfy network adequacy needs, and provider sophistication. “High Impact” providers historically receive onsite meetings, targeted telephonic outreach, email delivery of required contracting materials, and regular follow up efforts through the completion of the contracting process (contracting, credentialing, configuration, etc).
Network Adequacy
The evaluation of network adequacy has undergone significant evolution, necessitating a comprehensive toolkit to align with the demands of the industry. Our guiding principles establish a focused approach to address the challenges associated with network adequacy, empowering our team to glean unprecedented insights into network infrastructure, thereby facilitating the development of tailored strategies aimed at optimizing efficiency.
Blakemore Consulting delivers update tools proven to be successful through previous network development engagements. Network Adequacy updates are reported in terms of overall market adequacy, individual county/specialty adequacy, key System/Hospital/PHO/IPA contracting status, individual “gap fill” prospecting and/or contract status, and areas of contracting risk.
Our services provide access to cutting-edge insights within the industry, enabling us to expeditiously assess network adequacy and fulfill submission criteria through customized roadmaps tailored to each market’s unique requirements. We provide our clients with information pertaining to membership accessibility, encompassing geospatial mapping, network-to-network provider comparisons, and market-specific criteria such as time, distance, and minimum provider standards. Our data analytics methodology and proven reporting tools allow our clients to assess, model and prioritize network development efforts.
Our clients gain knowledge that allows for targeted provider prospecting, focused contracting strategies, and continued network adequacy monitoring.
Our clients are provided detailed information regarding membership accessibility in terms of geomaps, network-to-network provider comparisons, claims disruption, and Client specific time, distance and/or minimum provider standards. Additionally, our “what-if” network scenarios and “impact analysis” offer a profound understanding of the consequences of including or terminating various provider groups on adequacy metrics.
Our clients benefit from application of tools that assist with submissions for employer driven RFPs, provider network audits, regulatory adequacy requirements (MA, QHP, HMO / PPO, etc.), and network submission template uploads.