Build and Manage Networks with Complete Insight

Organizations often lack clear visibility into provider performance across cost, quality, and utilization, along with limited insight into referral patterns and network leakage. Without strong benchmarking against competitors or tools to model network changes, decision-making becomes reactive and risky.

Network Modeler unlocks insights across your market, including wallet share, network affiliations, and geographic clusters of patient activity in order to create and optimize high-performing networks. Dig deeper with national and local cost and outcome performance metrics for physicians, specialists, and provider groups. ​​

NETWORK MODELER

Design stronger networks with confidence

Comprehensive market intelligence​

Utilize national provider performance datasets across cost, utilization, and specialization. Use insights built on full Medicare population data to supplement internal data.​

Scenario modeling and simulation​

Model provider or group inclusion and exclusion to compare observed vs. expected performance before making network decisions.​

Strategize on market expansion ​

Evaluate new geographies using complete, multi-line of business market intelligence and modeling capabilities. ​

​Support specialty network design

Develop strategies for high-cost, high-impact specialties based on referral patterns and episodic performance. ​

Identify high-performing providers​

Analyze total cost of care, outcomes, quality, utilization, specialization, and referral behavior to pinpoint high-value providers across specialties and episodes of care.​

Referral and leakage insights

Visualize referral flows and identify leakage patterns to help strengthen high-value referral pathways.​

Meaningful Data. Measurable Impact.

10 +

Specialties evaluated across cost efficiency and quality performance1

13

High-value cardiology practices identified for a tiered network strategy (of 64 total)2

21

High-value practices identified as network growth opportunities2

1Available through Network Modeler. 2Network insights generated using third-party provider cost and quality data.

What Sets Network Modeler Apart

Network performance visibility

Analyze, interpret, and contextualize extensive provider performance datasets covering the entire country.

Strengthen network integrity

Using provider geography, specialty, and out-of-network utilization insights to promote high value referrals for member retention.

Turn provider data into negotiating power

Leverage detailed provider profiles and performance benchmarks to uncover opportunities, strengthen your leverage, and secure more favorable contract terms​.

Deliver value across your organization

Expand strategically with data-driven network insights.

  • Evaluate referral patterns, market dynamics, and provider performance to support physician alignment and network growth.
  • Identify opportunities to strengthen specialty networks by analyzing referral behavior, quality outcomes, and episodic performance.
  • Compare network configurations before expanding into new markets or service lines to understand potential performance impacts.
  • Use provider performance benchmarks to identify partnership opportunities and strengthen clinically integrated networks.
  • Build referral strategies that improve care coordination while keeping patients within high-performing networks.

Design stronger networks with confidence before making changes.

  • Model provider and network changes before implementation to understand their impact on cost, quality, utilization, and member access.
  • Identify high-performing providers using national benchmarks across episodes, specialties, and total cost of care.
  • Reduce leakage by understanding referral patterns and strengthening high-value in-network pathways.
  • Evaluate new markets and provider groups using comprehensive market intelligence and provider performance data.
  • Support network contracting with objective provider benchmarks and scenario modeling that strengthens negotiation strategies.

Build higher-performing networks that improve cost and quality outcomes.

  • Simulate provider and network changes before implementation to understand the impact on attribution, utilization, quality, and financial performance.
  • Identify high-value providers using objective cost, quality, referral, and episode performance benchmarks.
  • Strengthen referral pathways by uncovering leakage patterns and optimizing in-network provider relationships.
  • Evaluate market expansion opportunities with comprehensive market intelligence and provider performance comparisons.
  • Support network development with data-driven insights that improve provider selection, specialty coverage, and long-term performance.

Become proactive with your network strategy

Network Modeler empowers organizations to analyze, model, and compare providers in and out of network. Enabling insightful action into your network.

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