Quest Enterprise Services gives a Top 10 National Health System the

it needs to position itself for success with Payers.

WHO WE HELPED
A Top 10 National Health System

HOW WE HELPED
Quest Enterprise Services

The health system wanted to strengthen
its position with payers. To do this, it
needed a new way to prove that its
network included high-quality providers
and was in compliance with network
adequacy standards.

The Director of Network Development knew that without
a clear picture of the network’s participation, access, and
adequacy levels in all service areas, it would be difficult for
them to accurately assess the network on a continual basis.

“We needed a better understanding of
our networks before we went into payer
conversations,” said the health system’s Director
of Network Development.

In addition, the client wanted to streamline processes
within the organization and empower decision makers with
actionable insights. To accomplish their goals, they were
looking for a more robust, automated solution that could
provide them with precise data insights on each provider in
their database. They also wanted an easy-to-use interface
that would allow users across departments to quickly see
high-level key information, while also providing them
with the ability to drill down into more detailed data
when necessary.

GAINING CLARITY IN COMPLEXITY WITH QUEST ENTERPRISE SERVICES

The client worked with Quest Analytics® to find the right solution that would enable them to meet
their goals, while also improving the value proposition for payers. By using Quest
Enterprise Services, they were able to have a more comprehensive view
of their provider network.

QUEST ENTERPRISE SERVICES ENABLED THEM TO:

GATHER DATA

INTELLIGENCE:

Complete
visibility into
provider data and
the network in a
single, centralized
platform.

INCREASE

EFFICIENCY:

Save time and
resources by
automating
manual processes,
giving quick
access to data
empowered
employees to
make data-
driven decisions
and reducing
redundant
work across the
organization.

LEVERAGE

AUTOMATION:

Eliminate manual
processes
and speed up
processes that
would normally
take weeks or
months.

ACCELERATE

EXPANSION:

Precise data
insights are used
to understand
where the
network needs
to grow and
develop a plan for
acquisition of new
providers.

GAIN NETWORK

INTELLIGENCE:

Perform targeted
analyses to review
the existing
network and
strategically
plan for ways to
optimize in the
future.

PROVE

COMPLIANCE:

Built-in Federal
Network
Adequacy
Requirements.

STRONGER COMPLIANCE STRATEGY, STRONGER PAYER PARTNERSHIP

Quest Enterprise Services has been an important part of
the client’s strategy to develop high-quality networks
that meet CMS Network Adequacy requirements.

The Director of Network Development explained, “With the
tools I have from Quest Analytics, we take an offensive strategy
with payers. We can tell them, ‘We are adequate. We can be
your network in a particular area without any other providers
because we have everything covered from a CMS Medicare
Advantage Network Adequacy regulatory perspective.”

Quest Enterprise Services has also helped the client easily
identify specialty gaps in their network — and with a few clicks
of button, they can see which provider will fill the gap.

THE FUTURE WITH QUEST

ENTERPRISE SERVICES

Since implementation, the client has realized efficiencies
and leveraged the ability to view their networks across all
payers in all service areas. In turn, they are starting to see
greater success in their contract negotiations.

This got the team thinking about what’s next.

The client is beginning to focus on alternative payment
models and value-based reimbursement – looking
beyond the need for networks to be adequate to be high
performing in terms of cost and quality.

“We want to be able to align with the best
providers in terms of cost & quality and
remediate those in our network or those that we
employ, that aren’t the best. Looking forward,
what I would say we’re continuing to curate our
networks in a way that we can be efficient, that
we can meet regulatory requirements, and that
we can meet consumer expectations in terms
of their experience with our health system.”

UNLOCK YOUR ADVANTAGES

The client is working with Quest Analytics
to bring this vision to reality.

Data and analytics aren’t just information—
they’re where your competitive advantage
lies. With Quest Enterprise Services, you can
unlock the power of your data to drive business
decisions and propel your business forward.

Our team of experts is also here to help you
transform your information into actionable
insights so that you can make smarter,
faster decisions that positively impact your
bottom line.