October is Breast Cancer Awareness Month, and October 18 is National Mammography Day, making this month a time to reaffirm our commitment to early detection and prevention. For executives managing provider networks, this is more than a public awareness campaign—it’s a crucial opportunity to align your clinical mission with your financial strategy.
Delivering outstanding patient care, particularly for high-value services like mammography, is not at odds with maintaining profitability; it is, in fact, essential to it. Early detection dramatically reduces the need for costly, advanced treatment, stabilizing long-term medical expenditures and improving member outcomes—a direct win for your medical loss ratio (MLR).
The Executive Challenge: Balancing Access, Quality, and Cost
Your network is the most powerful tool you have to influence health outcomes and financial performance. When it comes to breast cancer care, executives must answer three core questions:
- Is access adequate? Can members easily find and schedule a mammogram?
- Is the quality high? Are your contracted imaging centers delivering accurate, timely results?
- Is the price right? Are you achieving cost efficiency without compromising the first two points?
From Awareness to Action: A Strategic Network Approach
The reactive approach—simply tracking utilization after a diagnosis—is no longer enough. TOG Network Solutions enables health plans to proactively manage their network around critical preventative services, transforming compliance into a strategic advantage.
Guarantee Member Access (Access & Availability)
Timely access is the cornerstone of early detection. Our platform helps you move beyond basic compliance checks to guarantee member access.
- Geographic Analysis: Identifying and closing crucial time-and-distance gaps for mammography and specialty breast care facilities.
- Appointment Availability: Monitoring provider data for accurate scheduling information to reduce friction for the patient.
Drive Clinical Outcomes (Quality & Performance)
Not all mammography centers are equal. Errors in imaging can lead to unnecessary follow-up costs and, critically, delayed diagnoses. Our network intelligence platform allows you to drive clinical outcomes.
- Targeting High-Value Providers: Utilizing quality scores, accreditation data, and performance metrics to preferentially route members to the most effective imaging centers and specialists.
- Reducing Avoidable Costs: Minimizing instances of false positives/negatives by contracting with high-performing facilities, stabilizing the cost associated with follow-up procedures.
Master Your Medical Spend (Cost & Contracting)
By strategically focusing your network on preventive care, you directly impact long-term financial stability. Our tools help you master your medical spend.
- Value-Based Contracting: Shifting from volume to value by identifying providers willing to contract on outcome-based metrics related to screening adherence and early-stage detection rates.
- Total Medical Expense (TME) Optimization: Showing the clear financial benefit of increased mammography utilization (a low-cost service) in avoiding expensive later-stage treatment. The ROI on early detection is one of the highest in health care.
The TOG Difference: Strategic Intelligence
October serves as an annual reminder that patient well-being is intrinsically linked to your health plan’s bottom line. By applying strategic network intelligence to services like mammography, you successfully fulfill your mission of delivering outstanding care while ensuring the financial stability required to serve your members for years to come.