Segal Company

Network Analysis

Segal works with multiemployer funds 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 the current network to see if it is comprehensive for participants' 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 participants 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 participants are using non-PPO providers
  • Reviewing PPO savings reports
  • Implementing a tiered network concept to steer participants to more cost-effective providers and hospitals
  • Soliciting competitive bids for PPO network options to assure that the fund is receiving the most competitive rates and best access available