At the recent AHIP 2025 conference in Las Vegas, Quest Analytics and Arcadia made a significant announcement regarding their data integration partnership. This collaboration is poised to provide payers with the tools needed to construct more competitive provider networks.
Quest Analytics offers detailed physician-level intelligence through a unified platform. In today’s healthcare landscape, provider performance insights are no longer just a compliance requirement but are increasingly seen as a key business driver. By incorporating advanced provider performance data into network design, payers can gain valuable insights into which providers deliver superior outcomes at an efficient cost.
This integration empowers health plans to make well-informed decisions when structuring and refining their provider networks. By identifying top-performing providers, payers can develop networks that not only offer high-quality care but also engage members effectively.
The importance of this partnership cannot be overstated. While health plans have access to data on provider cost and quality, many still struggle to create networks that stand out in a competitive market. This collaboration between Quest Analytics and Arcadia aims to bridge this gap and provide payers with the tools needed to enhance member engagement, improve risk arrangements with providers, and boost member acquisition and retention through data-driven quality transparency.
Quest Analytics’ data-driven SaaS platform allows clients to leverage both proprietary and third-party data to make informed network decisions. Their Provider Claims Insights (PCI) offers valuable metrics on claims activity, procedures, conditions treated, efficiency, effectiveness, and payer mix. By integrating elements of Arcadia’s CareJourney Provider Performance Index with Quest’s PCI solution, clients can access detailed metrics on physician cost and performance across over 250 episodes based on Arcadia’s Medicare fee-for-service claims data.
Steve Levin, CEO of Quest Analytics, highlighted the significance of this partnership with Arcadia in embedding care delivery intelligence directly into Quest Enterprise Services (QES) where network decisions are made. Arcadia’s impressive client roster includes major players such as Aetna, Cigna, Highmark Blue Cross Blue Shield, Intermountain Health, Ochsner Health, and the state of California.
Dr. Luke Hansen, CMO of Arcadia, emphasized the shift towards building networks optimized for performance rather than just adequacy. By utilizing intelligence on provider performance, payers can identify those providers who consistently deliver high-quality care at lower costs. This approach enables the creation of networks that are not only compliant but also optimized for cost and clinical performance.
In conclusion, the partnership between Quest Analytics and Arcadia represents a significant step towards empowering payers to build more competitive and effective provider networks. By leveraging advanced data analytics and provider performance insights, health plans can enhance the quality of care they offer to members while also driving efficiencies and cost savings. This collaboration underscores the growing importance of data-driven decision-making in the healthcare industry.
For more information, feel free to contact the writer at SMorse@himss.org.
