Build a network designed to win, with lower costs, higher quality, and market-leading performance. This eBook is a strategic guide for health plan executives aiming to improve network performance, reduce cost of care, and strengthen competitive positioning in a margin-constrained environment. It highlights how underperforming provider networks can leave 2–6% of spend unrealized while outlining structural challenges — such as fragmented data, misaligned incentives, and rising administrative complexity — that hinder optimization. Focused on practical, actionable insights, the playbook centers on several core concepts: The key levers that drive network performance , such as network strategy, provider sculpting, and aligned contracting models that support sustainable outcomes The shift toward value-based care , with guidance on how and when to balance fee-for-service and risk-based arrangements to improve cost, quality, and utilization A step-by-step roadmap to network optimization , covering goal setting, benchmarking, provider segmentation, performance monitoring, and member steerage strategies Provider partnership and engagement models , emphasizing collaboration, incentive alignment, and operational efficiency to strengthen long-term network value Line-of-business-specific strategies across Medicare Advantage, Medicaid, Commercial, and ACA, recognizing that a one-size-fits-all approach limits performance Built for executive decision-makers, this playbook demonstrates how leading health plans translate analytics into action — turning network optimization into a continuous, enterprise-wide capability and a lasting source of competitive advantage.
