Wakely Network Evaluation & Strategy Tool (NEST)
Move Beyond Adequacy. Build a Network Advantage.
Meeting adequacy requirements is no longer enough. Wakely’s Network Evaluation & Strategy Tool (NEST) helps health plans understand where their networks can compete, where vulnerabilities exist, and where action will have the greatest impact through a dynamic web-based platform.
NEST is an integrated network strategy platform that moves plans beyond adequacy into competitive positioning, action prioritization, and network design. It enables Medicare Advantage organizations to evaluate provider networks using network adequacy, quality, cost, utilization, and competitive insights in one place. Instead of piecing together information from multiple systems, your team can see the factors that matter most when making network decisions.
How Does NEST Help Medicare Advantage Organizations?
Managing provider networks requires balancing regulatory compliance, provider performance, cost management, member access, and long-term business strategy. As Medicare Advantage plans become increasingly competitive, organizations need more than network adequacy reporting, they need integrated analytics that support smarter decision-making.
NEST combines network adequacy, provider quality, utilization, cost, and competitive analytics into a single platform. Developed by Wakely’s Medicare Advantage experts, it enables organizations to evaluate provider networks through both an operational and an actuarial lens.
By bringing multiple data sources together, NEST helps organizations:
- Improve long-term network planning
- Support provider contracting decisions
- Strengthen regulatory readiness
- Evaluate provider performance
- Make confident, data-driven strategic decisions
See Your Network Through a Different Lens
During a personalized demonstration, we’ll show how NEST evaluates your network, highlights opportunities, and supports smarter decision-making.
Tool Overview
NEST simplifies the process of evaluating and optimizing provider networks in a competitive environment. Use NEST to:
Compete with Confidence
Gain a comprehensive view of the competitive landscape and benchmark network strength against competitors. Compare networks across markets, counties, providers, and specialties to identify opportunities for growth, differentiation, and stronger market positioning.
Understand how your network compares to competitors on utilization, outcomes, and quality.
- Benchmark network strength regionally, nationally, or by county
- Identify provider-level performance variations down to the National Provider Identifier (NPI)
- Support more effective rate negotiations with quality-based insights
Focus Action Where It Matters
Identify adequacy gaps, at-risk areas, and provider performance opportunities. Prioritize recruitment, contracting, remediation, and other network actions based on where they will have the greatest impact. Support Health Service Delivery (HSD) submissions to the Centers for Medicare & Medicaid Services (CMS) and remediation planning.
- Pinpoint adequacy shortfalls at the county or regional level
- Prioritize recruitment efforts to strengthen compliance and coverage
Drive Strategic Network Design
Use provider-level performance, affiliation, adequacy, and competitive insights to refine network strategy. Scenario-test network configurations before acting and build networks that support both adequacy and competitive advantage.
- Evaluate risk scores and Hierarchical Condition Categories (HCC) prevalence across provider panels
- Identify opportunities for value-based arrangements at the provider level
- Align network design with market growth, profitability, and quality goals
What Provider Networks Get with NEST
Every network decision has financial, operational, and regulatory consequences. NEST helps health plans evaluate provider networks with a more complete view of performance so teams can identify opportunities, support compliance, and strengthen strategic planning.
Common Challenges
- Understanding whether your network is positioned for long-term success, not just compliance
- Balancing provider quality, cost, access, and utilization
- Comparing your network with competitors
- Identifying providers to recruit, retain, or reevaluate
- Bringing network, actuarial, and clinical teams together around a shared view of performance
How NEST Helps
NEST enables organizations to:
- Give network, actuarial, and executive teams a shared source of truth
- Analyze network adequacy alongside provider quality, utilization, and cost
- Benchmark network performance against competitors
- Support provider contracting with quality and financial insights
Getting Started with NEST
Wakely works closely with each client to ensure a successful implementation and adoption process. From initial onboarding through ongoing support, our team helps organizations integrate NEST into existing workflows while minimizing disruption.
Getting started with NEST is simple: Wakely guides onboarding and typically completes setup within two weeks of receiving signed subscription agreements, giving your team access to provider-level analytics without anything more than your provider roster.
Wakely makes it easy for your team to use NEST with practical training resources and user guides, support coordinated through your organization’s designated administrator, and options for additional customer success services tailored to your needs and subscription agreement.
How Much Does NEST Cost?
Pricing is tailored to each organization’s needs.
NEST is offered through an annual subscription tailored to the scope of each organization’s needs. Pricing reflects the number and relative cost profile of the states included, the organization’s Medicare Advantage enrollment, and the breadth of geographic coverage. Multi-state and national arrangements are priced to recognize the efficiencies of broader coverage.
Who Uses NEST?
Medicare Advantage Health Plans
Health plans use NEST to evaluate provider networks, improve strategic planning, support network adequacy, and prepare for market expansion.
Provider Network Teams
Provider network managers leverage NEST to compare provider performance, identify contracting opportunities, and uncover network gaps.
Actuarial Teams
Actuarial professionals use NEST alongside utilization, quality, and financial analytics to support forecasting and strategic decision-making.
Healthcare Executives
Executive leadership uses NEST to evaluate organizational performance, reduce financial risk, and guide long-term network strategy.
When Organizations Should Use NEST
NEST delivers the greatest value when organizations need strategic visibility across their provider networks.
Preparing for CMS Network Adequacy Reviews
Evaluate network readiness before regulatory submissions and identify potential coverage gaps.
Expanding into New Markets
Assess provider availability and network strength before entering new service areas.
Evaluating Provider Performance
Use quality, utilization, and cost metrics to evaluate provider effectiveness.
Supporting Value-Based Contracting
Identify providers who align with quality improvement and financial objectives.
Benchmarking Against Competitors
Understand how your network compares within the market and identify opportunities for improvement.
How NEST Evaluates Provider Networks
Provider Data Analysis
Build a stronger network with a clearer view of provider performance. NEST combines comprehensive network data, best-in-class provider cost, effectiveness, and appropriateness information, and medical economics data created through the Virtual Research Data Center (VRDC) to help you better understand provider panels and inform network strategy. Wakely brings these sources together through its analytical expertise to help you identify opportunities and make more confident network decisions. We regularly update NEST’s data and metrics to bring you the latest available insights for informed network decisions.
Network Adequacy Evaluation
Move beyond compliance with a clearer view of network readiness. NEST evaluates provider and facility networks against applicable CMS minimum sufficient provider requirements and time-and-distance standards, pinpointing gaps by county, specialty, and service area, and helping prioritize recruitment and remediation. Support CMS-compliant Health Service Delivery submissions while combining adequacy, provider performance, affiliations, and competitive insights to guide access, growth, and network strategy.
Quality, Cost, and Utilization Analysis
Get a more complete view of provider value with quality, cost, utilization, and patient risk insights in one place. NEST lets you explore performance across individual providers, facilities, markets, and networks to identify meaningful variation and opportunities for improvement. Use these insights to strengthen contracting discussions, evaluate value-based opportunities, and shape a network that supports quality care and financial sustainability.
Competitive Benchmarking
See how your network stacks up against competing Medicare Advantage networks across markets, counties, providers, and specialties. NEST helps you benchmark network composition and strength, identify shared providers and differences in network participation, and uncover competitive advantages and vulnerabilities. Put these insights to work as you plan market entry, prioritize provider recruitment and retention, refine contracting strategy, and design a more competitive network.
Why Organizations Trust Wakely
Many organizations already have established network adequacy processes. NEST isn’t designed to replace what’s working, it’s designed to provide deeper strategic insight that helps organizations make more informed network decisions.
Developed by Wakely’s Medicare Advantage experts, NEST reflects the real-world challenges health plans face every day.
Medicare Advantage Consulting Experience
Put deep Medicare Advantage experience behind your network decisions. Wakely has advised health plans, providers, and risk-bearing organizations since the program’s early years and prepares and certifies hundreds of MA and Part D bids annually across a broad range of plan types. Our work spans financial forecasting, risk adjustment, Star Ratings, benefit strategy, provider contracting, network development, and regulatory change, giving us a practical understanding of how network decisions connect to overall plan performance. NEST brings that actuarial discipline and market perspective to network strategy, helping your team weigh access, quality, cost, and competitive positioning together, not in isolation.
If your needs extend beyond NEST, Wakely offers targeted consulting and services to help turn insights into action. From deeper analysis to tailored strategic guidance, our experts work with your team to address specific challenges and help you achieve the results that matter to your organization.
Actuarial Expertise Behind NEST
Wakely brings more than data to your decisions. We combine deep healthcare actuarial expertise, advanced analytics, and proprietary benchmarks with practical experience advising health plans, providers, employers, and state programs. Our practicing actuaries and analytics specialists connect the numbers to the financial, regulatory, and market forces behind them, helping you understand what drives performance, evaluate tradeoffs, and identify where to act. NEST brings this combination of analytical rigor and real-world perspective to network strategy, helping your team look beyond individual metrics to make more informed, confident decisions.
Designed to Fit Your Workflow
Build on what works. NEST complements your existing tools and network management processes with a broader view of provider performance and network opportunity—so your team can strengthen decisions without replacing established workflows.
- Explore familiar provider data in a broader strategic context
- Bring actionable insights into everyday network planning and management
- Add strategic depth to your existing analytics investments
- Evaluate network decisions with a more complete picture and greater confidence
Built on Transparent Analytics
Make confident network decisions with a clearer understanding of the analysis behind them. NEST combines Wakely’s actuarial methodologies with transparent analytics to help your team understand how measures are developed, interpret results in context, and evaluate tradeoffs. This clarity helps stakeholders align around insights they can trust and put into action.
Frequently Asked Questions
How does NEST evaluate provider networks?
NEST combines network adequacy, provider quality, utilization, cost, and competitive analytics to provide a comprehensive evaluation of provider network performance.
What data does NEST analyze?
NEST brings together comprehensive network data, best-in-class provider cost, effectiveness, and appropriateness information, and Medicare insights from the VRDC, including utilization and patient risk. These insights are backed by Wakely’s actuarial and analytical expertise and designed to help you compare providers, evaluate network performance, and identify opportunities to strengthen your network. We regularly update NEST’s data and metrics to provide the latest available information to guide your decisions.
How does NEST support provider contracting?
NEST combines quality, cost, utilization, and competitive insights to help you compare providers, prioritize recruitment and retention, and evaluate value-based opportunities. Backed by Wakely’s actuarial expertise, these insights strengthen contracting discussions and align contracting decisions with your access, quality, and financial goals.
How is NEST different from traditional network adequacy tools?
Unlike traditional network adequacy tools focused primarily on compliance, NEST combines actuarial expertise with broader analytics that support strategic network planning.
Does NEST replace our current network adequacy tools?
Yes. NEST is designed to provide all of the functionality of existing Medicare Advantage network adequacy analytics while simultaneously providing deeper strategic insights.
How long does it take to begin using NEST?
Most organizations are up and running within two weeks of signing a subscription agreement. Wakely leads onboarding, and your team can start without uploading protected health information or patient records.
