National Health Plan Builds

Recent Works

Please reference the portfolio content to learn more about projects associated with National Health Plan builds.

Network Expansion – Midwest

  • Executed an 87-county commercial exchange expansion in the Midwest region for the Health Plan’s priority service area.
  • Prioritized the target list using the Quest Analytics mapping tool to identify “must have” providers based on a combination of utilization/claim volume/location. 
  • Network development inclusive of hospitals, individual and large professional organizations, behavioral health facilities and ancillary service providers.

Network Expansion – Southeast

  • Successfully executed a 54-county commercial exchange expansion in the Southeast region for the Health Plan’s priority service area.
  • Prioritized target list using the Quest Analytics mapping tool to identify “must have” providers based on a combination of utilization/claim volume/location. 
  • Network development inclusive of hospitals, individual and large professional organizations, behavioral health facilities and ancillary service providers.

Network Expansion – VA MDE’s

  • Under the Veterans Benefits Administration Medical Disability Examinations (MDE) contract, efforts were provided to aid the U.S. Department of Veterans Affairs in delivering & executing quality compensation & pension examinations to Veterans & separating Service Members seeking benefits for service-connected health issues.
  • Network Development to secure contracts with providers for medical, audio, mental health, vision, traumatic brain injury and dental exams for Veterans in 30 states.

New Market Entrance – Northeast

  • Executed a 16-county commercial exchange new market entrance in the Northeast region for the Health Plan’s priority service area.
  • Developed a high-performance network that provided equitable access to care, met regulatory requirements and unit cost objectives, allowing the health plan to concentrate partnerships with high quality providers in order to provide a low cost, attractive product.