Networks By Design

What Networks By Design does

Networks By Design, Inc. is a privately held California corporation headquartered in Tracy, CA, that builds and manages customized medical provider networks (PPO, MPN, and EPO) for B2B clients. The company serves workers' compensation payors and self-insured employers, group health payors and employers, and auto liability insurers, with its primary footprint in California and a national expansion launched in September 2024 through partnerships with national PPO networks covering more than 2.1 million providers across all 50 states.

The core technology is a proprietary provider network management platform that supports client-driven network configuration by state, zip code, and Taxpayer Identification Number (TIN), filtered by best rate, appeal history, and customer relations. Supporting features include a Provider Directory Search Tool with geographic and specialty filtering, a Telehealth Provider Platform, and a Provider Nomination System where clients request additions with a 2-business-day response. The company emphasizes proprietary medical outcomes data, utilization management guidelines aligned with California's MTUS framework, and exclusive provider contracts containing cost containment provisions such as lien filing timelines and prior authorization requirements.

The revenue model combines recurring subscription-style network access and management fees with professional services revenue from provider recruitment. Pricing is quote-based and not publicly disclosed; contracts appear multi-year. Distribution is exclusively through direct enterprise sales led by the principals, with no consumer or retail channel. Notable customers include Republic Indemnity (workers' compensation) and Hilmar Cheese Company (employer health plan).

Name

Networks By Design

Legal name

Networks By Design, Inc.

Website

https://netbyd.com

Company type

Private

Founded year

2015

Operating status

Operating

Headcount range

11–50 employees

Short description

Networks By Design is a privately held California corporation that builds customized PPO, MPN, and EPO medical provider networks for B2B clients including workers' compensation payors, self-insured employers, and group health insurers, primarily in California with recent national expansion.

Ownership category

akta.pro rank

Product category

Healthcare Provider Networks

SIC

Services-Health Services (8000)

akta.pro primary industry

Workers’ Compensation PPO Networks (HLAEANAH)

akta.pro secondary industries

National PPO Networks (HLAEANAA), Auto/No-Fault PPO Networks (HLAEANAI), Provider Network & Care Management for Commercial Members (HLAEAAAL)

Keywords

• Workers compensation networks
• Medical provider networks
• Group health PPO
• Auto liability networks
• California healthcare networks

Headquarters

HQ city

Tracy

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales

Revenue model

1. Network Access and Management Fees: Revenue generated from providing access to customized provider networks (PPO, MPN, EPO) for workers' compensation, group health, and auto liability clients. Fees likely structured as network access fees or per-member-per-month charges based on the B2B nature of the business.
2. Provider Recruitment Services: Provider recruitment services for clients with specific provider nominations, supporting network customization.

Pricing tiers

Go-to-market motion2 records

Distribution channels2 records

Marketing channels2 records

Core offering

Networks By Design develops and delivers client-customized medical provider networks in California, including Workers' Compensation MPNs, Group Health PPO/EPO networks, and Auto Liability networks. The company provides payors, insurance carriers, employers, and public entities with access to vetted healthcare providers along with proprietary data management technology to administer and report on network utilization.

Product overview

Networks By Design operates as a client-customized medical provider network company offering three integrated core products: Workers' Compensation Medical Provider Network (MPN), Group Health PPO/EPO Network, and Auto Liability Provider Network. The company recently expanded its National PPO Network (September 2024) offering over 2.1 million providers nationwide. Supporting these core networks are complementary features including a Provider Directory Search Tool with geographic and specialty filtering, Telehealth Provider Platform for remote care, and a Provider Nomination System for client-driven provider recruitment. All networks are built on proprietary medical outcomes data rather than commodity network data, enabling truly client-driven custom network configurations.

Differentiator

Problem solved

Functional benefit

Products and services

• Workers' Compensation MPN

Quantifiable outcome

• Significant medical expense savings through customized network focus on best possible care and treatment
• +2 more outcomes

Named customers2 records

Segments4 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature4 records

Partnerships

One partnership is on record.

• National PPO NetworkscoreChannel Partner/ Reseller/ Distributor · 17 September 2024Networks By Design has partnered with national PPO networks to offer clients access to over 2.1 million providers throughout the United States. This partnership enables the company to serve national clients with client-driven custom networks and QA programs beyond California.

Scale indicators6 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• Galaxy Health Network: Galaxy Health Network is a privately held PPO/EPO network manager offering customized provider network solutions to payors and employers. Closely comparable in scale and customization-focused business model to Networks By Design.
• Zelis: Zelis provides healthcare network management, claims cost containment, and payment integrity services to payers and employers. Its network and cost-containment offerings overlap directly with Networks By Design's custom PPO/MPN, custom QA, and provider configuration capabilities.
• CorVel Corporation: CorVel is a national workers' compensation managed care company offering provider networks, utilization management, and claims management. It is a direct competitor in California workers' comp MPN and medical cost containment where Networks By Design focuses.
• Evolutions Healthcare Systems: Evolutions Healthcare Systems is a privately held PPO and MPN network management company serving payors, employers, and TPAs with customizable provider networks. Closely comparable in business model and mid-market positioning to Networks By Design.
• USA Managed Care Organization (USAMCO): USAMCO provides managed care, provider network, and utilization management services focused on workers' compensation and group health. It competes in the same California-centric, custom-network niche as Networks By Design.
• MedRisk: MedRisk is a workers' compensation specialty managed care company focused on physical therapy and ancillary provider networks. It overlaps with Networks By Design's workers' comp MPN, particularly in California, on provider network and utilization management.
• One Call Care Management (now One Call): One Call provides workers' compensation network and care coordination services, including diagnostic, physical therapy, and specialty provider networks. It is a direct competitor in workers' comp provider network management.
• Stratose (formerly Coalition America / AMPS): Stratose operates a national PPO network and cost containment services for payors, TPAs, and self-funded employers. It is a comparable custom-network and supplemental network competitor in the same mid-market segment.

Broad incumbents

• MultiPlan (now Claritev): MultiPlan/Claritev is the largest independent PPO network manager in the U.S., offering national and supplemental provider networks to payors, employers, and TPAs. It is the broadest incumbent benchmark for Networks By Design's custom-network value proposition.
• Carelon Health (Elevance Health network services): Carelon (formerly Aspire/CareMore), part of Elevance Health, operates broad national PPO networks (including the legacy First Health network) and integrated care management. It is a scaled incumbent competitor in custom network solutions and national PPO reach.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/networks-by-design-mpn-ppo
• Xx.com/netbyd

Revenue estimate

Valuation estimate

Number of profiles

Profiles4 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Networks By Design