Payers

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  • Our payer partners accelerate go-to-market, reduce regulatory compliance issues (ie network adequacy, accuracy), and access analytical support to help design a network to match strategy. 
  • Carenodes networks make it possible for payers to tailor access as market and regulatory forces demand. Our payer partners benefit from the breadth of network management, contracting, and market-driven services when navigating business strategy. We help payers maintain network adequacy, accuracy, and accelerate their go-to-market / expansion plans by providing an instant network of providers. 

 

Some of our prominent network designs:

 

  • National primary PPO network
  • Select regional primary networks 
  • Complementary “wrap around” network
  • Non-medical service provider networks (to address SDoH and provide Medicare Advantage Supplemental benefit packages)
  • Specialty networks
  • Acute and post-acute networks
  • Telehealthcare delivery networks 

 

All of our providers are telehealth-enabled; most of our providers are also DEAx waiver-ed. When Carenodes signs a  ‘plan-sponsor’, we partner closely to accelerate network development, contracting, and implementation efforts in strategic markets. A network compare is usually conducted to assess competitor footprint, competitor projected degree of network accuracy, and their risk of network adequacy to identify specific areas of target to ensure smooth and successful market entry.

 

We also partner with brokers / enrollment agents and our provider network to help expand our prayer-partners’ footprint in a certain market.

 

As a strategy, Carenodes network is performance based while focusing on access expansion. Carenodes works with its provider network to model their impact in terms of network value to a given risk-bearing entity. Our PCP network is driven by incentives tied to IHA/AHA, RAFs, and P4Ps and are capitation-minded. Most of our PCP network consists of providers with a ‘path to value’ model.

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