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HEALTHCARE

Narrow Networks Model Paves Way for Better Healthcare Outcomes


The Challenge

A leading health insurance company chose to shift to a “narrow-network” model to tackle rising costs and inefficiencies. The company designed 426 narrow networks for 30 U.S. markets, only with providers that deliver high-quality services at lower costs. The company approached Cognizant to implement the shift to the narrow-network model.


Our Approach

To implement and maintain the narrow networks, Cognizant needed to design new processes. We built a team of healthcare technology experts with critical thinking skills to frame the new design and then maintain the narrow networks. Utilizing design thinking principles, we ensured that the processes were customer- and provider-centric and that all stakeholders, including the provider, payer and processor, were considered. Because narrow networks tend to be more fluidic—about 10% of the data changes every month—maintaining data and assuring its accuracy are a challenge. 

However, we created a model based on a three-step, analytics-driven procedure to combat these problems. First, the data is examined as it reaches the system’s repository. Then defects are identified in the data. Finally, a network health audit is conducted to ensure data accuracy. After following this three-step procedure, data accuracy exceeded the targets from the previous year.

A Model That Upgrades the Experience for Providers and Members

In 18 months, Cognizant helped the company establish more than 426 networks in 30 markets—up from 33 networks in four markets—with 50 percent cost savings and 99.5 percent data accuracy, up from 95 percent.


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Established

426 networks in 30 markets

Improved

data accuracy to 99.5%, from 95%

Saved

50% of operating cost


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