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Understand how referral patterns impact
your medical loss ratio with 

Network Explorer

The Challenge

Understanding and managing network performance is essential for health plan profitability 

As employers increasingly demand accountability for controlling healthcare costs, understanding provider network performance has never been more important for payers. 

Without insights into physician referral patterns, health plans cannot contextualize or maximize their network performance to achieve their MLR targets. 

In Network BCBS TX Negotiated Rates at Surgery Centers for Dallas-Fort Worth-Arlington TX
Network Explorer

Learn how physician decisions impact your MLR 

Computer screen showing rendering of Network Explorer

Network Explorer enables visibility to...

Network Misalignment

Physician Referral Relationships  
Discover referral patterns among primary care providers, specialists and sub-specialists at the market level. 

Rendering of the Downstream Rendering Provider Chart

Site of Service Analysis 
Analyze the facilities where specialists render care, and at what volume, to inform high-value networks.  

Provider Alignment Chart

Manage your MLR in near-real-time 
Assess your network performance – and your competitors’ – longitudinally in near-real time.  

Data Features

Discover opportunities to improve your MLR across… 

Analyze physician behavior across Commercial, Medicare, Medicaid and Medicare Advantage
Discover where you members receive high-volume procedures to quantify network performance
Primary Diagnosis Code
Exponentially Better

Comprehensive insight to improve network performance 

Chart comparing Trilliant Health vs. claims clearinghouse data and your own data
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Additional Data-Driven Insights for Health Plans

A Field Guide to Survive Healthcare's Negative-Sum Game

Field Guide To Survive Healthcare’s Negative-Sum Game 
An essential resource for every health economy stakeholder who understands the need to compete seriously in healthcare’s negative-sum game. 

Read the Field Guide >

Distribution of Price vs. Quality Measures vs. HCAHPS Scores

Employers Care About Value for Money, Not Value-Based Care 
Producing value for money for employers requires value-based competition by providers across every service line, meaning that open networks and any willing provider statutes are essential.  

Read the Full Analysis >

Anthem BlueCross BlueShield of Illinois vs. UnitedHealthcare negotiated rates for MS DRG 420 for a single provider at two locations

Employers Are Paying More for Less 
Market concentration and price are not correlated, and there is substantial variation in negotiated rates in markets with similar levels of competitiveness.

Read the Full Analysis >

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