Optimize common beneficiary referral pathways by closing referral loops, detecting 2nd and 3rd order provider referral behavior to out-of-network PCPs and other redundant providers, evaluating out-of-network providers for strategic growth, assessing the risk of beneficiary reattribution, and strengthening network performance for more efficient and coordinated care pathways.
Identify common referral pathways from in-network resources to downstream in– and out-of-network providers to close open referral loops and recover revenue opportunities.
Evaluate in-network and 2nd and 3rd order out-of-network providers based on referral behavior to decrease unwarranted out-of-network leakage.
Assess primary care providers who are placing beneficiaries at risk for reattribution and engage at risk beneficiaries for in-network consultations to reduce the risk of repatriation.
Identify high-value and high-volume out-of-network providers for engagement to strengthen network performance.
Reduce unnecessary leakage to out-of-network primary care providers, particularly those affiliated with other VBC program.
Spotlight your network’s most central providers within hidden communities of high-cost care in your network to facilitate contract negotiations and optimize funds-flow.