Coverage scored for every county and specialty, weighted by how Medicare patients actually use care and counted against the 65-plus population. The same scores that drive your executive dashboard export as the network-adequacy file you submit to CMS — one set of numbers, two destinations.
Network adequacy · live
Endocrinology · Diabetes · Sample service area
Counties
6
in service area
Adequate
2
≤ 10 patients/provider
Critical
1
action required
County coverage · patients per provider
01
Network adequacy is where a plan can lose the right to grow. Miss a threshold and CMS can freeze enrollment until you remediate. The hard part isn't the filing — it's keeping operations and compliance honest about the same network. This puts both on one number.
02
Most plans run network-adequacy in compliance and run dashboards in operations — and the two systems disagree. We compute county × specialty × disease coverage scoring on every provider data refresh, store it pre-computed, and serve it to both surfaces. The number the CFO sees is the number CMS sees.
03
A diabetic Medicare patient sees a PCP first (family medicine, internal medicine), then potentially endocrinology, podiatry, ophthalmology, nephrology, and cardiology. The legacy 1:1 disease-to-specialty mapping says 'no endocrinologists in the county = critical gap' when 50 PCPs manage diabetes daily. Our coverage scoring weights specialties by realistic patient share — and the ratios start telling the truth.
04
All-age BRFSS data inflates patient counts by 3–5× because Medicare Advantage only covers 65+. We use CDC PLACES age-adjusted prevalence and Census ACS 65+ population. The ratio you read in the dashboard is the one a 65-year-old will actually feel.
05
The HSD table CMS expects in HPMS exports directly from the same dataset — not a derived view. Specialty taxonomy, county-of-service mapping, distance computation: all auditable, all reproducible from the upstream provider data.
Ready when you are
If your provider data is ready, a new white-labeled tenant goes live in about a week. Compliance certification runs alongside it, not as a later phase.
