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Network Optimization Strategies for Payers: A Look at Provider Network Adequacy

Clarify Health

A well-balanced and adequately resourced provider network is a strategic asset for payers in the highly competitive healthcare insurance market. When looking to optimize, it is critical to ensure network adequacy or the provider network’s ability to meet the healthcare needs of an insured population.

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Clarify Health and Ideon Partner to Build Stronger, More Competitive Health Plan Networks

Clarify Health

Clarify Health is leveraging Ideon, the industry’s most accurate and comprehensive provider-network data solution, to improve health plan management, lower costs and promote high-quality healthcare. Health plans can use this intelligence to expedite their decision-making processes for network modeling and optimization.

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How TPAs Can Use Network Design as a Competitive Advantage

Clarify Health

With deep expertise in the healthcare and insurance fields and in-depth knowledge of industry standards, laws, and regulations, they can help businesses plan health benefits, streamline processes, and manage costs. Networks must be accessible to all employees and adequate for their needs.

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Three Strategies to Optimize Healthcare Provider Networks in New and Existing Markets

Clarify Health

Optimizing provider networks is the number one way to do so. Provider networks are the primary tool for health plans to attract and retain new members while optimizing returns. This makes network design a key factor in any member retention strategy. Payers are constantly looking to improve member outcomes while lowering costs.

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A global health insurance company improves the precision of hospital ratings for its Centers of Excellence designations

Clarify Health

A large, global health insurance company has a Centers of Excellence (COE) program that annually evaluates its network hospitals on patient outcomes and cost efficiency. As a result, they strengthened the value of their COE designation, improved patient outcomes, and increased member retention. “By

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Headway Raises $125M, Reaches Unicorn Status

MedCity News

The company connects patients to in-network therapists and helps mental health providers avoid the massive administrative burden associated with taking insurance. The round brings the New York-based startup’s valuation to $1 billion, reaching unicorn status.

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Healthcare is about profits, not patients

World of DTC Marketing

They said “medical claims and revenues noticeably declined among hospitals during the height of the pandemic, which has benefited health insurers. The post Healthcare is about profits, not patients. HCA’s second-quarter profit was roughly $1.1 billion, a 38% increase from the same period a year ago. Changes are imminent.