Network Design

Network Design is a capability that risk-bearing entities use to identify and partner with high quality providers. Network Design is often an important precursor to value-based contracting because larger groups will have more negotiation leverage and because a high performing network of providers allows for more control over costs and other value-based care outcomes. Companies that provide Network Design services are typically also able to provide Care Navigationservices.

Criteria:

  • Analytics to evaluate provider quality and/or provider cost

  • Ability to evaluate and advise on network adequacy, or network completeness against a set of service- and geography-based requirements

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Serif Health
Claimed

Serif Health

Company Info
Founded: 2020
Headcount: 1-10
Customers
Verified Customers: 7
Customers Served: Digital Health Provider, Ambulatory Practice, Hospital / Health System, Health Plan, Employers, Life Sciences
Product Overview
2 Reviews
Serif Health provides healthcare pricing intelligence through APIs and self-serve analytics tools. Their platform processes machine-readable pricing data from health plans to deliver clean, actionable insights. These tools help provider organizations benchmark reimbursements, optimize pricing strategies, and improve contract negotiations. Health plans use Serif Health for network management and cost-effective care guidance, while employers and innovators utilize their data for plan audits, direct contracting, and integrating cost data into new healthcare products.
Company Info
Founded: 2020
Headcount: 11-50
Customers
Customers Served: Digital Health Provider, Ambulatory Practice, Hospital / Health System, Health Plan, Employers, Government
Product Overview
The Denniston Data Provider Ranking System ranks healthcare providers based on data such as procedure volume and geographic comparisons. It helps users identify high-volume, experienced providers for specific procedures and make informed decisions within a given area. The system uses transparent grading criteria based on provider experience and other relevant metrics.
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CareJourney

CareJourney

Company Info
Founded: 2014
Headcount: 51-200
Customers
Verified Customers: 1
Customers Served: Digital Health Provider, Ambulatory Practice, Hospital / Health System, Health Plan, Life Sciences
Product Overview
Security and Compliance Certifications: HITRUST CSF
CareJourney is a healthcare analytics platform that specializes in offering pre-packaged claims data alongside data integration capabilities. The platform features advanced tools for benchmarking physician performance, providing insights into cost, quality, referral patterns, and patient volume. CareJourney provides analytics for patient segmentation and other value-based care models, helping organizations adapt to evolving payment structures.
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Clarify Health

Clarify Atlas

Company Info
Founded: 2015
Headcount: 201-500
Customers
Verified Customers: 3
Customers Served: Digital Health Provider, Ambulatory Practice, Hospital / Health System, Health Plan, Life Sciences
Product Overview
Clarify Health's Atlas platform is an enterprise analytics solution with over 15 billion claims in its dataset that can be used for price transparency in contract negotiations, building higher quality networks, reducing spend, and optimizing referrals. The platform aids in optimizing provider performance, reducing medical costs, and improving patient outcomes by integrating social determinants of health and detailed patient data.
Definitive Healthcare logo
Definitive Healthcare

Definitive Healthcare

Company Info
Founded: 2011
Headcount: 501-1000
Customers
Customers Served: Life Sciences, Health Plan, Hospital / Health System
Product Overview
Security and Compliance Certifications: SOC 2 Type 1, HIPAA
Definitive Healthcare is a data and analytics platform that provides detailed profiles of healthcare providers, market level data on providers, and trends in healthcare utilization and outcomes. Their platform serves a variety of uses cases, most notably life sciences marketing functions.
Company Info
Founded: 2017
Headcount: 51-200
Customers
Customers Served: Health Plan, Employers
Product Overview
Security and Compliance Certifications: HITRUST CSF, HIPAA
Embold Health is a provider data and analytics company that specializes in assessing physician performance. Embold evaluates physician adherence to evidence-based medicine, patient outcomes, and cost-effectiveness. They are primarily used by employers and health plans for network design and care navigation tools and services. Additionally, they offer provider engagement tools to provide feedback to physicians on value-based care performance.
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Garner Health

Garner Health

Company Info
Founded: 2019
Headcount: 51-200
Customers
Customers Served: Digital Health Provider, Ambulatory Practice, Employers, Health Plan, Risk-Bearing Providers
Product Overview
Security and Compliance Certifications: SOC 2 Type 2
Garner Health uses a claims database with over 60 billion records from 320 million patients to identify healthcare provider quality for use in care navigation. They offer products for care navigation, as well as the dataset for use in other applications.
J2 Health logo
J2 Health

J2 Health

Company Info
Founded: 2020
Headcount: 11-50
Customers
Customers Served: Health Plan
Product Overview
J2 Health is a provider analytics company that helps health plans design provider networks that meet network adequacy, quality and marketability standards.
Lumeris logo
Lumeris

Lumeris

Company Info
Founded: 2000
Headcount: 1001-5000
Customers
Customers Served: Digital Health Provider, Ambulatory Practice, Hospital / Health System, Risk-Bearing Providers
Product Overview
Lumeris is value-based care company that provides health systems, payers, and providers operational support, technology, and consulting services. Lumeris advises on VBC contracting and offers risk-sharing options to strengthen its partnerships. They also provide technology, analytics and operational support to enable performance in VBC models.
Privia logo
Privia

Privia

Company Info
Founded: 2007
Headcount: 501-1000
Customers
Customers Served: Ambulatory Practice, Hospital / Health System, Health Plan, Risk-Bearing Providers
Product Overview
Security and Compliance Certifications: HIPAA
Privia is a national physician organization focused on administrative, financial and clinical outcomes in value-based delivery structures. Privia’s operations are structured regionally and encompass employed physician practices, physician networks aggregated through ACO and IPA structures, and MSOs that provide administrative services to medical groups. They can support providers along the spectrum of independence and risk ownership in value-based care structures. They also offer population health management tools to support. Privia also provides contracting and network design services for health plans and larger risk-bearing health systems.
Company Info
Founded: 2015
Headcount: 51-200
Customers
Customers Served: Ambulatory Practice, Hospital / Health System, Risk-Bearing Providers
Product Overview
Security and Compliance Certifications: HIPAA, ISO 27001
Trella Health is a healthcare analytics company that offers data, analytics and consulting solutions primarily geared towards post-acute care and referral management. Their Marketscape strategy solutions include analytics to support network design and cost reduction and their platform solutions include EHR data integration services and a CRM to manage patient relationships and grow patient volume.
Turquoise Health logo
Turquoise Health

Turquoise Health

Company Info
Founded: 2020
Headcount: 51-200
Customers
Verified Customers: 4
Customers Served: Digital Health Provider, Ambulatory Practice, Hospital / Health System, Health Plan, Employers
Product Overview
Security and Compliance Certifications: SOC 2 Type 2
Turquoise Health is a data platform that provides price transparency data and payer-provider contracting solutions. Their price transparency data platform enables pricing through competitive benchmarking and customized rate setting, particularly for value-based reimbursement structures such as bundled rates. Their managed care contracting software enables more efficient rate negotiations.