Why is building a network so challenging?

There are 6 core reasons: provider group and hospital consolidation, changing government regulations, fast-moving competitors, scattered information sources, new market unknowns, and fixed resources for variable needs.

Providers have more contracting leverage:

The share of primary care physicians affiliated with vertically integrated health systems increased from 38 percent to 49 percent from 2016 to 2018.1

— Health Affairs

As such, it’s increasingly difficult to aggregate provider data into an integrated, leverageable profile. Not to mention the other 5 factors.

This playbook identifies a prescriptive 3-step process for a successful network build, and offers an overview of the Zelis Network Builder & Optimizer capabilities.

1 Furukawa, M.F, Kimmey, L., Jones, D.J., Machta, R.M., Guo, J., & E.C. Consolidation Of Providers Into Health Systems Increased Substantially, 2016–18. Health Affairs, Vol 38. No. 8. https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00017

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