Use case
Use case3 min readBy The Data Workers Team

Network performance data, run by agents

Provider directories, contracts and claims sit in separate systems, so adequacy and performance reports are assembled by hand. Here is how Data Workers runs it instead.

Key takeaways

  • •The problem today. Provider directories, contracts and claims sit in separate systems, so adequacy and performance reports are assembled by hand.
  • •What changes. Agents join provider, contract and claims data into one governed network view and keep it current as directories change.
  • •What stays with your people. Published adequacy filings: regulators review them.
  • •The result. Network teams see adequacy and performance on current data.

The problem today

Provider directories, contracts and claims sit in separate systems, so adequacy and performance reports are assembled by hand.

What changes with Data Workers

Agents join provider, contract and claims data into one governed network view and keep it current as directories change.

The workflow: Connectors agent (get_connector_status) → Pipeline Building agent (generate_pipeline) → Quality Monitoring agent (run_quality_check) → Data Context & Catalog agent (define_business_rule).
Fig. 1:The workflow: Connectors agent (get_connector_status) → Pipeline Building agent (generate_pipeline) → Quality Monitoring agent (run_quality_check) → Data Context & Catalog agent (define_business_rule).

The workflow, step by step

  1. 1.The Connectors agent calls get_connector_status and lands provider directory and contract data.
  2. 2.The Pipeline Building agent calls generate_pipeline and builds the governed network model.
  3. 3.The Quality Monitoring agent calls run_quality_check and checks directory accuracy.
  4. 4.The Data Context & Catalog agent calls define_business_rule and defines adequacy and performance metrics.

The impact metrics we move

  • •Directory change reflected: from about 2 weeks to 4 h
  • •Adequacy report: from about a week to 2 h
  • •Provider scorecard refresh: from about a month to 1 day
Time to complete, current practice (black) vs. with Data Workers (green). Illustrative.
Fig. 2:Time to complete, current practice (black) vs. with Data Workers (green). Illustrative.

What goes on autopilot

  • •Directory changes flow into the network model the day they happen, so adequacy is never reported on stale networks.
  • •Provider metrics are governed, so contracting and quality agree.

Where your people stay in charge

Published adequacy filings always go to a named approver, because regulators review them. Everything starts at L1, observing only, and autonomy rises only on evidence.

The pilot

  • •Scope. Directory-to-claims join for one market.
  • •First week. Agents run at L1, observing only, and show the fixes they would have made, with receipts.
  • •By week two. The routine work above runs on its own; anything sensitive stays with a named approver.
  • •At day 30. We review the impact metrics against your baseline:
  • •Directory change reflected: from about 2 weeks to 4 h
  • •Adequacy report: from about a week to 2 h
  • •Provider scorecard refresh: from about a month to 1 day
  • •Cost. Start with a pilot ($7,500 one-time, credited in full against the first year). Scale is from $1,000 a month and Enterprise from $3,000 a month, billed annually, with unlimited seats, no usage meter and no markup on model spend. See pricing.

Related: The health plans and payors hub · The full team playbook

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