Build a High-Performing Specialist Network. Reduce Leakage. Improve Outcomes.
EnsureXCEL™ is the network intelligence and referral optimization module of the VBC OS™ — built to identify top-performing specialists, design premium networks, and steer referrals to reduce leakage, cut specialty variation, and align your network with VBC contract performance goals.
The Network & Referral Pain Points EnsureXCEL™ Eliminates
Referral Leakage
Without real-time visibility into referral patterns, out-of-network referrals accumulate silently — eroding shared savings performance, inflating specialty spend, and undermining VBC contract results before anyone notices.
No Performance Data at the Point of Referral
PCPs and care coordinators refer to specialists based on familiarity, not performance. Without outcomes and cost data embedded in the referral workflow, high-cost, low-quality referrals happen by default.
Specialty Cost Variation
Unmanaged specialist variation drives unpredictable episode costs and erodes the financial performance of risk contracts. Most organizations lack the analytics to even quantify the variation, let alone act on it.
Premium Network Design Complexity
Building a high-performing or narrow network requires scoring hundreds of specialists across multiple dimensions. Without an automated solution, this work takes months — and is usually stale by the time it is done.
No Cost-Share Steering Infrastructure
Even when preferred specialists are identified, member cost-share tiers are rarely structured to steer volume toward them. Without the right incentives, preferred network design remains theoretical.
Disconnected Data and Workflow Systems
Referral decision support tools that exist outside the EMR workflow are ignored at the point of care. If the recommendation requires a separate login or lookup, it will not be used consistently.
Everything You Need to Build and Optimize a High-Performing Network
Every EnsureXCEL™ capability is CTF™ — Customizable to Fit your organization, contracts, and workflows. Deploy the full module or embed individual capabilities via API.
Performance-Based Specialist Identification
Rank in-network and out-of-network specialists by risk-adjusted outcomes, cost efficiency, and episode performance — so you know exactly who belongs in your high-performing network and who does not.
- Specialist ranking by risk-adjusted outcomes and cost efficiency
- Episode performance analysis across specialty and geography
- In-network vs. out-of-network performance comparison
- Continuous rescoring as new claims and clinical data arrive
Premium & Narrow Network Configuration
Configure premium or narrow network tiers by specialty and geography with reduced member cost-share to steer referral volume toward your best-performing specialists — live in under 90 days.
- Premium and narrow network tier configuration by specialty and geography
- Reduced member cost-share steering toward preferred specialists
- Network launch and configuration in under 90 days
- Ongoing network performance monitoring and reconfiguration
EMR-Embedded Referral Decision Support
Surface the preferred, in-network specialist directly within the existing EMR referral workflow — guideline-concordant recommendations delivered in under 10 seconds, at the exact moment the referral is made.
- Preferred specialist recommendation inside existing EMR referral workflow
- Guideline-concordant recommendations in under 10 seconds
- No separate system login or workflow disruption for care teams
- Configurable integration profiles per EMR platform
Real-Time Referral Leakage Monitoring
Continuously monitor out-of-network referral patterns, flag leakage as it happens, and quantify the revenue and quality impact of every out-of-network referral decision — before it compounds across a performance year.
- Real-time out-of-network referral monitoring by specialty and provider
- Leakage alerts with revenue and quality impact quantification
- Leakage trend analysis by PCP, care coordinator, and service line
- Configurable leakage thresholds and escalation alerts
Member Cost-Share Incentive Design
Design member cost-share incentives that make it financially sensible for patients to choose preferred, high-performing specialists — structuring the economic incentives that make network steering actually work.
- Cost-share tier design by specialist performance tier and specialty
- Member-facing incentive modeling and impact analysis
- Integration with health plan benefit design and enrollment systems
- Ongoing cost-share performance tracking and optimization
Live Data Warehouse Connection
One-click live connection to the EnsureVAULT™ data warehouse. Specialist scorecards and leakage reports always reflect current claims and clinical data — no manual exports, no stale reports, no lag between data and decision.
- Live connection to EnsureVAULT™ claims and clinical data
- Real-time scorecard refresh as new data arrives
- No manual data exports or refresh cycles required
- Configurable data schema and reporting cadence
How Organizations Use EnsureXCEL™
Premium Network Launch for MA Product
A Medicare Advantage plan uses EnsureXCEL™ to identify top-performing cardiologists and orthopedists, configures a premium network with reduced member cost-share, and steers referrals toward it — reducing specialty variation while improving outcomes.
Referral Leakage Elimination for ACO
An ACO monitors out-of-network referral patterns in real time via EnsureXCEL™, flags leakage as it happens, and quantifies the revenue and quality impact — enabling proactive intervention before leakage compounds across a performance year.
Point-of-Referral EMR Integration
A primary care group embeds EnsureXCEL™ into their Epic referral workflow. PCPs see the preferred, in-network specialist recommendation in under 10 seconds — without leaving the EMR or disrupting existing processes.
Cost-Share Incentive Design for Medicaid MCO
A Medicaid managed care plan uses EnsureXCEL™ to design member cost-share tiers that incentivize choosing preferred specialists — driving volume toward high-performers while reducing total specialty spend.
Narrow Network Configuration for VBC Contracts
An MSO configures a narrow specialist network through EnsureXCEL™ tailored to VBC contract performance requirements — selecting specialists by risk-adjusted outcomes and cost index to optimize shared savings performance.
Ongoing Network Performance Monitoring
A health system uses EnsureXCEL™ to continuously monitor specialist performance across the network — identifying underperforming providers and adjusting network configuration before the next contract renewal cycle.
Ready to Build Your High-Performing Specialist Network?
Join health plans, ACOs, and provider groups using EnsureXCEL™ to identify top-performing specialists, design premium networks, and reduce referral leakage. Request your tailored demo today.