Agile Network Management
Agile Network Management
Agile Network Management (ANM) enables payers to differentiate their value for each customer segment by aligning the product and care model designs with the underlying network designs. It ensures network performance by facilitating the selection of appropriate providers into networks and the alignment of provider reimbursement with network design objectives.
Business Challenges
- Complexity and effort in introducing new networks and products
- Supporting new network designs such client specific networks, narrow networks, specialty networks, etc.
- Steering members from health insurance exchanges to optimal providers and care teams
- Increased demand for tailored/personalized networks by employer adoption of VBID and VBP
- Claims system’s inability to support new network designs and associated reimbursement policies
- Ability to scale new care delivery models, such as ACOs and PCMH from pilot
Key Features
- Network analysis
- Criteria-based network eligibility & scope design
- Products to networks mapping (network product offering)
- Networks to contracts mapping (contract provider grouping)
- Contracts to reimbursement mapping
- Network modeling
- Network guideline enforcement
- Network hierarchy
- Automated network deployment and maintenance (system-driven provider to network affiliations)
Key Benefits
- Increased competitive differentiation through enablement of product and network innovation
- Increased health value and economic value through improved network performance
- Decreased administrative costs and cycle times for network management
- Enablement of provider rate differentiation to drive provider performance
- Increased member steerage through alignment of benefit and network designs
Solution(s)
