Elevance Health Inc.
NETWORK DESIGN AND OPTIMIZATION

Abstract:

A computer-implemented method for selecting one or more providers having one or more specialties for a network available to members while satisfying one or more constraints, the method comprising: at a first computing device: receiving, from a second computing device separate and distinct from the first computer, a network provider request to select an optimized network of providers, the request including: a desired objective including at least one of provider cost minimization, provider average quality maximization and provider total volume maximization, one or more geographical designations, computing an optimized provider network of one or more selected providers including: applying a model that produces a non-optimized provider network of one or more providers having one or more specialties that satisfies the desired objective for the one or more geographical designations of the members without consideration of the availability in the geographical designation of one or more providers having one or more specialties, and applying a linear decomposition to the pre-optimized provider network to generate an optimized provider network; providing the optimized provider network to the second computing device.