Network gap analytics — The numbers that survive the audit.
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
- County 017.2
- County 029.4
- County 0314.1
- County 0422.6
- County 0517.8
- County 0611.3
01
Why this matters to your plan.
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
The same data on both sides of the wall.
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
Care-pathway-weighted thresholds.
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.
- Each disease maps to a care-pathway with specialty roles and patient-share %
- Adequate ≤ 10 patients/provider; moderate ≤ 20; critical above
- Per-specialty benchmarks (cardiologists and family medicine have very different panel capacities)
04
Medicare-aged population denominators.
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
HSD-table-ready.
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
Bring this platform to your plan.
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.