Provider Network Optimization

Provider network optimization has become a major focus for all healthcare organizations trying to address over-utilization, prevent referral and network leakage, and manage provider performance. Improved transparency between payers and providers is critical to enabling the creation and sustainability of an efficient and effective high-performance network.

Enable your care and quality teams with actionable intelligence to uncover opportunities around cost savings, utilization management, network optimization, and physician performance.

Provider Network Leakage Dashboard

Provider Network Leakage Dashboard

The QualMetrix Provider Network Optimization solutions enable care and quality teams to:

  • Understand, track and measure key performance indicators
  • Identify and compare the cost of services from avoidable ER visits–to readmissions–to complications
  • Drill down into specific costs and utilization by member/patient
  • Investigate network leakage risks and opportunities by group, PCP, or member/patient
  • Quickly evaluate providers to determine performance level based on 16 industry standard criteria sets