Segal Company

Network Analysis

Sibson Consulting works with employers 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 your current network to see if it is comprehensive enough for your employees' 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 employees 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 employees are using non-PPO providers
  • Reviewing PPO savings reports
  • Implementing a tiered network concept to steer employees to more cost-effective providers and hospitals
  • Soliciting competitive bids for PPO network options to assure that you are receiving the most competitive rates and best access available
  • Using our proprietary network disruption methodology, which uses five data points to ensure accuracy, and comparing not just the number of providers who will be displaced, but the number of services and employees affected by this displacement