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narrow network

narrw_ntwk_ind
quality·Updated Jun 23, 2026

Definition

ISO-11179 Definition

A boolean indicator identifying a health plan product that contracts with a selected subset of providers rather than the broadest available provider network, enabling lower premium costs in exchange for more limited provider choice by excluding providers with higher costs or lower quality performance. Narrow networks are designed to concentrate patient volume with the most efficient and highest-quality providers, generating lower average costs that allow health plans to offer more competitive premiums in individual and employer markets. The tradeoff of lower cost for limited choice makes narrow networks controversial — member satisfaction is lower when preferred providers are excluded, and access concerns arise when narrow networks lack sufficient specialists or geographic coverage.

Healthcare data teams analyze narrow network composition by measuring quality and cost efficiency distributions of included versus excluded providers, modeling premium reduction potential from different network configurations, evaluating adequacy of the narrow network against CMS and state regulatory access standards, and tracking member utilization patterns to verify that narrow network design is achieving intended cost efficiency outcomes.

Standard Abbreviation

narrw_ntwk_ind

Category

quality

Production DDL — FACT_QUALITY_MEASURE

FACT_QUALITY_MEASURE.sql
CREATE OR REPLACE TABLE FACT_QUALITY_MEASURE (
    qlty_key        INTEGER        NOT NULL  -- surrogate key,
    mbr_key         INTEGER        NOT NULL  -- FK to DIM_MEMBER,
    plan_key        INTEGER        NOT NULL  -- FK to DIM_PLAN,
    meas_yr         SMALLINT                 -- measurement year,
    hedis_meas_cd   VARCHAR(20)              -- HEDIS measure code,
    denom_ind       CHAR(1)                  -- denominator eligible,
    numer_ind       CHAR(1)                  -- numerator met,
    excl_ind        CHAR(1)                  -- exclusion indicator,
    gap_open_ind    CHAR(1)                  -- care gap open,
    star_rtg_nbr    DECIMAL(3,1)             -- star rating,
    qlty_scr        DECIMAL(5,2)             -- quality score,
    perf_thrsh_pct  DECIMAL(5,2)             -- performance threshold,
    raf_scr         DECIMAL(10,3)            -- risk adjustment factor,
    outreach_cnt    SMALLINT                 -- outreach attempts,
    load_dt         TIMESTAMP_NTZ  NOT NULL  -- load timestamp
);

Standard Snowflake DDL for the canonical quality table. Convert to BigQuery or Databricks →

Why This Term Matters

Quality measure data determines how payers and providers are rated and reimbursed under CMS Stars, HEDIS, and value-based care contracts. Data engineers who understand quality terminology build measure calculation pipelines that correctly attribute patients, apply denominator exclusions, and flag documentation gaps before submission deadlines. Incorrect quality data directly affects star ratings, pay-for-performance bonuses, and Medicare Advantage plan bids.

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