By Tina Gallagher, Network Strategy & Development Program Lead, ATTAC Consulting Group
I just returned from the 15th Medicare Stars, HEDIS®, Quality & Risk Summit, and one theme ran through nearly every session I attended: the conversation around provider access has fundamentally changed.
It wasn’t coming from one presenter or one corner of the industry. Quality leaders, network executives, compliance teams, and member experience officers were all saying some version of the same thing. Plans that treat provider access as a compliance function are already behind. The question is no longer whether you’re meeting the standard. The question is what you’re doing with the data the standard generates.
That distinction matters more than most organizations currently recognize.
Three Phases of Provider Network Strategy
When I look at how health plans approach provider network strategy, I see a clear evolution playing out across the industry, though not everyone is moving at the same pace.
Phase one is network adequacy: do we have enough providers, in the right specialties, within required geographic parameters? This is foundational work, and it remains critically important. But it’s the floor, not the ceiling.
Phase two is network optimization: are those providers actually accessible? This is where access and availability surveys come in, measuring whether members can get an appointment within required wait times, whether directories are accurate, whether after-hours care is available. You’re testing whether the network works in practice, not just on paper.
Phase three, where the most forward-thinking plans are heading, is predictive provider network strategy. The question shifts from where are our gaps today to where will our gaps be 12 to 18 months from now, before they show up in member complaints, CAHPS scores, corrective actions, or star ratings performance.
In practice, that looks less like an annual snapshot and more like an ongoing read on the network. It means tracking appointment availability trends in close to real time rather than once a year. It means watching provider panel closures and new-patient acceptance rates by specialty and geography the same way plans already track utilization or pharmacy data. It means risk-stratifying network gaps the way plans risk-stratify members, so the specialties and regions most likely to fail next aren’t a surprise when they do.
Adequacy is the floor. Optimization is the ceiling. The ceiling keeps rising.
How to Turn Provider Access Data Into Network Intelligence
Here’s what I find most compelling about this moment: most plans don’t need new data sources to get to phase three. The information is already coming back from access and availability surveys. Most organizations just aren’t treating it as strategic intelligence.
Leading organizations are starting to connect the dots between access and availability survey findings and a broader picture of network health, including appointment availability trends, member complaints, provider feedback, referral patterns, new patient acceptance rates, provider panel closures, and third-next available appointment data.
Taken together, this is an indicator of where your network is under strain today, and where it will be under strain next year. The access survey isn’t a compliance deliverable. It’s often the first signal of a network problem that hasn’t shown up anywhere else.
The survey is not the end of the process. It’s the beginning of the strategy.
The plans that translate this into action tend to do it the same few ways. A recurring executive review where network, quality, and compliance look at the same data together, instead of three separate reports landing on three separate desks. An enterprise scorecard that tracks network risk alongside CAHPS and HEDIS, not next to it. Recruitment and contracting decisions that start from the survey findings instead of starting from a complaint.
When those survey findings inform targeted provider recruitment, specialty expansion, behavioral health network development, and capacity-focused contracting, that’s when access data becomes a strategic asset.
Provider network development is no longer just a contracting function. It’s a strategic performance capability.
Why Provider Network Strategy Requires Cross-Functional Alignment
At the Summit, the other consistent theme was this: plans that are winning on access aren’t doing it in departmental silos. Quality, network management, compliance, and member experience: the most effective organizations are working from the same data toward the same outcomes.
This matters practically because access and availability data touches every part of the plan. Appointment availability and directory accuracy directly drive CAHPS access measures, Getting Needed Care and Getting Appointments and Care Quickly, and every HEDIS gap that requires a visit to close. A network access problem is also a quality problem and a member experience problem, often before anyone has named it as such.
Members experience outcomes. They don’t experience our organizational chart.
There’s a provider side to this too. Providers who feel buried in disconnected outreach, duplicate data requests, and administrative noise don’t just disengage. They cap new patient volume, close panels, or leave the network. Every one of those is a network adequacy problem with a provider-relations root cause. The plans making progress here are consolidating provider-facing communication, aligning incentives, building joint advisory councils instead of one-way mandates, and treating provider experience as a leading indicator of network stability rather than a separate initiative.
A provider who feels burdened by your organization doesn’t just disengage. Eventually, they close their panel.
The plans making real progress on predictive network strategy are the ones that have connected these functions: sharing data, aligning incentives, and building toward a common definition of what network performance actually means. That alignment shows up in concrete ways: shared scorecards instead of departmental ones, incentive structures where network and quality leaders are measured on some of the same outcomes, and governance that gives someone enterprise-wide ownership of network risk instead of leaving it split across departments.
The Question Every Network Leader Should Be Asking
What leading indicators are you monitoring today that tell you where your network will be under strain 6 to 18 months before it shows up in results?
Most plans can’t fully answer that question yet. The ones building toward that capability now are also rethinking who’s accountable for the answer. Predictive network strategy isn’t a better report for the network team to produce. It’s a capability that has to sit with leaders who can act across quality, compliance, provider relations, and member experience at once.
That’s the shift the industry is signaling. Based on what I heard at the Summit, it’s no longer a question of whether this evolution is coming. It’s a question of who gets there first.
Tina Gallagher is Network Strategy & Development Program Lead at ATTAC Consulting Group, where she leads provider network strategy and development for health plan clients. She brings more than 25 years of experience building Medicare, Medicaid, and Marketplace networks and applying value-based payment models, including prior P&L and state and regional plan president roles with Harmony / Wellcare of Missouri and Southern Illinois, UnitedHealth Group of Mississippi and Molina Healthcare of Missouri.
ATTAC partners with health plans to design and execute provider access and availability surveys that deliver network intelligence, not just compliance reporting.
