A Guide to AI-Driven Network Design

About this episode: AI is a tool for reaching a goal, and health plan leaders get the most from it by starting with the problem they need to solve. Chris Lance, Chief Product Officer at Quest Analytics®, and Adam Sullivan, an independent consultant who previously led data science work at Change Healthcare and Labcorp, explain how to tell when AI is the right tool for health plan provider network management.  The conversation gives you a way to sort those goals by what AI actually changes for the business and to spot where it does not belong.  What You'll Learn  A practical way to tell whether AI is the right tool for a given problem  Where AI has opened up work that used to be out of reach for health plan network teams, and where it creates new problems to manage  Why the data underneath an AI feature matters more than the model, and what that means for build versus buy  How to measure whether an AI feature is working six months after launch  When Health Plans Should Use AI  Start with what matters to the business and what it is struggling with, then apply AI to that problem. Chris describes three roles AI can play, which are creating new problems to solve, solving problems that were out of reach, and improving jobs already being done. A rules-based method that returns the exact answer is the better fit for decisions such as care coverage and reimbursement.  Why Data Matters More Than the AI Model  Flawed data produces wrong predictions and decisions that are not good for members. For example, ghost networks show the risk. A network can look adequate on paper while the providers listed in it are not available to members.  Build Versus Buy for Health Plan AI  Chris says the owner of the outcome should decide whether to pursue the work at all, and a viable product that already exists is better bought than rebuilt. Adam adds that being able to build something does not mean a team should. He suggests the strongest AI talent belongs on high-value problems rather than on replacing a software subscription.  How to Measure Whether an AI Feature Is Working  Set a goal and capture a baseline before launch, then measure progress against both. Adam recommends building monitoring in on day one and tracking the value created alongside token spend.  Related Resources  Listen to the previous episode in this series on the data science perspective. Read more on the Quest Analytics blog about ghost networks and the Meet Quinn™ AI assistant.  Guests: Chris Lance, Chief Product Officer, Quest Analytics  Adam Sullivan, Independent Consultant  Moderated by Lucas Voss, Becker's Healthcare  Host: April Beane, VP of Marketing, Quest Analytics®  

About This Episode  Payers are confident AI belongs in provider network management. The question is whether the data underneath it can keep up. In this episode, we bring you a recent webinar recorded with Quest Analytics and HLTH, built around a new Becker's Healthcare survey of 103 health plan executives on the gap between AI ambition and data reality. Subhash Seelam, Deedar Samant, and Nebojsa Milosavljevic break down what the survey found and what it means for the plans and provider organizations trying to close that gap. They cover:  Why network accuracy and directory integrity outranked cost reduction as the top AI priority  The difference between having an integrated platform and having unified data  Why ghost providers are the weakest-performing gap in the survey, even with a vendor already in place  What payers value most in a data partner, and why it's rarely price  Guests  Subhash Seelam, Chief Data Officer, Quest Analytics®  Deedar Samant, VP of Network Management, CommonSpirit Health  Nebojsa Milosavljevic, Data Science Manager, Quest Analytics  Host  April Beane, VP of Marketing, Quest Analytics 

Everyone talks about the importance of clean, accurate provider data, but who's actually doing the work to make that real? In this episode of The Totally Adequate Podcast, host April Beane brings two members of Quest Analytics' data science team out of the lab and onto the mic.  Subhash Seelam and Nebojsa Milosavljevic don't usually show up in marketing materials. They show up in datasets,  identifying anomalies, building models, tracing relationships between providers, facilities, physician groups, and health systems that most people assume are already properly connected. (Spoiler: they're not.)  In this episode, you'll hear about:  What data scientists actually do, and why the role at Quest Analytics is unique  Why the provider data problem is fundamentally a hierarchical one, and what that means for health plans  How experimentation, failure, and unexpected discoveries lead to better models  The principle behind the work: when the foundation isn't solid, everything built on top of it costs more  What the future of provider data looks like, and why the industry is finally starting to converge on the right answer    This episode is a conversation with the people doing work that most health plan professionals never see. Work that determines whether a member can actually find an in-network doctor, whether a compliance calculation is based on accurate data, and whether everything downstream is built on something solid.  "When the foundation isn't solid, everything built on top costs more." — Subhash Seelam    Guests:  Subhash Seelam, Chief Data Officer, Quest Analytics®  Nebojsa Milosavljevic, Data Science Team Lead, Quest Analytics  Host: April Beane, VP Marketing, Quest Analytics 

About this Episode Recorded live at Quest Analytics® Vision Quest 26 in Chicago, this episode brings together a patient and a clinician for a candid conversation about what provider networks mean at the human level. Shanna Adamic — author, speaker, and six-year patient navigating misdiagnosis, fragmented care, and a life-saving brain surgery — interviews Dr. Luke Hansen, Chief Medical Officer at Arcadia, on why the work of building networks is mission-driven work.   Topics Covered  Shanna's six-year patient journey — and what it taught her about fragmentation, misdiagnosis, and the importance of connected care  Dr. Hansen on why clinical medicine defaults to the most common diagnosis, and what it takes to get to the right answer  Why a "contracted network" and an "accessible network" are not the same thing — and what health plan professionals can do about it  How the networks our clients build create real-world access for real people  Why both guests believe we may be entering the first truly intelligent era of healthcare  Guests:  Shanna Adamic — Author, Audacious Optimism; Director, Oracle Health Executive Content & Oracle TV  Dr. Luke Hansen, MD, MHS — Chief Medical Officer, Arcadia  Host:  April Beane, VP of Marketing, Quest Analytics®

About this Episode Provider data plays a central role in delivering on the promise health plans make to their members. Its accuracy and reliability strengthen trust with patients and partners, meet regulatory requirements, and drive opportunities to leverage AI innovations. In this episode, we talk with industry experts about why reliable provider data is foundational to network strategies and using AI responsibly. We walk through practical steps healthcare leaders can take to strengthen their data, protect trust, and support better outcomes—for members, providers, and the business.  Guests:  Robert Holzer, Strategy & Innovation Leader, Next Horizon Innovations LLC Bob Tavernier, Solution Executive, Quest Analytics® Martin Luethi, Chief Technology Officer, Quest Analytics® Host: April Beane, VP of Marketing, Quest Analytics®

About this Episode: Success in provider network management starts with the right partners by your side. In this episode of The Totally Adequate Podcast, host April Beane sits down with Meghan Harrison and Eun Perry from Quest Analytics' Client Services team for an honest and engaging conversation about how authentic partnerships lead to powerful results. From supporting Medicare Advantage, Marketplace, and Medicaid network submissions to strategizing network expansions and uncovering hidden opportunities in data, Harrison and Perry have seen it all. They share their experiences, lessons learned, and advice for success in network management. Offering a behind-the-scenes perspective, they reveal how working hand-in-hand with Quest Analytics' clients streamlines complex processes, improves efficiency, and reduces the risk of costly missteps for teams managing provider networks.  Discover how meaningful partnerships can make all the difference. Guests:  Eun Perry, Client Services Consultant, Quest Analytics®   Meghan Harrison, Client Services Manager, Quest Analytics®

About this Episode: Provider data accuracy and network strategy are strategic priorities for health plans to consider. With heightened regulatory scrutiny, evolving network adequacy standards, and rapid AI adoption, data integrity sits at the center of compliance, member experience, and innovation. Steve Levin and Scott Westover deliver a high-level, executive-focused discussion on the forces reshaping provider data and network strategy. They break down:  Key regulatory and market trends that are influencing provider data and network management  The growing role of AI in provider data management  How government perspectives around consumer-facing data are changing  Strategies for leadership teams focused on aligning systems with modern member expectations in 2026 and beyond  Guests:  Steve Levin, CEO of Quest Analytics   Scott Westover, Chief Network Solutions Officer, Quest Analytics  April Beane, VP of Marketing, Quest Analytics 

About This Episode Join a candid conversation about the realities of navigating healthcare today. Hear how system-level gaps can delay care, and how industry innovators are using AI and technology to improve the patient experience. Shanna's journey brings the stakes to life, showing why care before crisis must become the new standard. Guests:  Shanna Adamic, Director, Oracle Health Executive Content and Oracle Video Executive @ Oracle | Oracle TV Co-Anchor, AI World | Keynote Speaker | Published Author of Audacious Optimism | Former NFL KC Chiefs Cheerleader   Barbara Dumery, Chief Product Officer, Quest Analytics® An engineer by training, Barbara has more than 20 years of experience bringing innovative technology solutions to the market that address key challenges in healthcare. She has a track record of driving value to customers and clients that drive exceptional growth to the business. At Quest Analytics®, Barbara helps drive the expansion of current solutions as well as new innovations off of Quest Analytics' core offerings. Previously, she has served in leadership roles in companies across all facets of healthcare – from population health analytics, medical devices, speech recognition, and radiology imaging. Barbara holds Bachelor's and Master's Degrees in Electrical Engineering from Tufts University.   April Beane, VP Marketing, Quest Analytics  

About This Episode  In this episode, we share a technical-to-operational playbook that covers data quality issues and AI-driven network design. Join our guests as they break down a data-first approach that enables success.   How to identify and fix data issues that break analytics and ML.  How to use real-world data to inform design and contracting.  How executives evaluate AI proposals and the artifacts that accelerate approval.  Guests:  April Beane, VP Marketing, Quest Analytics   Stephen Gold, Senior Advisor at Vestar Capital Partners and former Chief Information Officer (CIO)  James Lamb, Vice President of National Payers at Quest Analytics®

Guests:  Bob Tavernier, Solutions Executive, Quest Analytics | Connect on LinkedIn  Joshua Abraham, Director of Network Strategy, CommonSpirit Health   Host: April Beane, VP of Marketing, Quest Analytics | Connect on LinkedIn   About This Episode  Affiliation intelligence is transforming the development and optimization of healthcare networks, offering payers new pathways to enhance operational performance and member outcomes. April Beane sits down with industry leaders Bob Tavernier and Joshua Abraham to discuss how payers are using affiliation data to build high-performing and sustainable networks. Hear about practical, data-driven approaches to overcoming complex network challenges, including:  Identifying hidden contracting relationships that influence network performance.  Uncovering strategic opportunities for market growth and expansion.  Recognizing entities that can address multiple network adequacy gaps.  Aligning provider and facility participation to reduce out-of-network costs.