## 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.