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Network Analysis
Segal works with public sector entities to create health care networks that are cost effective and comprehensive. We have experience with a variety of networks, including:
- Preferred provider (PPO) networks, which are based on a combination of diagnosis-related group (DRG) and per diem payments to hospitals
- Health maintenance organization (HMO) programs in which primary care physicians (PCPs) are paid a capitation rate, hospitals a per case rate, and specialty physicians a fixed schedule of fees
- Point-of-service (POS) programs in which PCPs function as gatekeepers for all in- and out-of-network care
- Specialty networks of behavioral health practitioners and facilities
- Dental PPOs, in which dentists are paid according to a pre-determined fee schedule, or DEMOs, in which each patient selects a primary care dentist who then coordinates all dental care needed by the patient
- PPO networks of vision providers that offer significantly discounted rates for examinations and a selection of frames, lenses and contacts at reduced prices
Our network analysis services include:
- Adding a PPO network if none currently exists and creating a plan design for in- and out-of-network services
- Investigating your current network to see if it is comprehensive enough for your employees' current needs. This includes hospitals, physicians, skilled nursing facilities, home health, hospice, rehabilitation facilities, physical/occupational/speech therapists, chiropractors, and durable medical equipment (DME)
- Using data to guide employees to Centers of Excellence to improve treatment outcomes and promote patient safety. This includes all procedures prone to high rates of quality variability
- Investigating why employees are using non-PPO providers
- Reviewing PPO savings reports
- Implementing a tiered network concept to steer employees to more cost-effective providers and hospitals
- Soliciting competitive bids for PPO network options to assure that you are receiving the most competitive rates and best access available
