The weekly cadence.

The most reliable predictor of whether a network build finishes on time is whether the leadership team has a weekly operating review that they actually run from. Not a status email. Not a dashboard nobody opens. A meeting where the contracting pipeline, the credentialing queue, the adequacy gap, and the open issues are reviewed against the plan, and where decisions get made on the spot.

Most organizations have something they call a weekly review. What they actually have is a progress report meeting — someone presents numbers, leadership nods, and nothing gets decided. The difference between a review that works and one that doesn't is entirely in the agenda design.

The agenda that works

The weekly network management review should run 45 to 60 minutes. It has five sections:

1. Go-live date check (5 minutes). Is the go-live date still achievable? Not a general sense — a specific answer based on current contracting velocity, credentialing pipeline, and any regulatory changes since last week. If the answer is no, or uncertain, that surfaces immediately and the rest of the meeting adjusts accordingly.

2. Adequacy status (10 minutes). Which counties are adequate, which are at risk, which are confirmed gaps. The adequacy model should be refreshed weekly during the build, not monthly. Any county that drops below the adequacy threshold since the last review gets flagged and a recovery action assigned.

3. Contracting pipeline (15 minutes).Contracts signed this week, contracts expected to close next week, contracts stuck and why. The pipeline review should be provider-specific — not aggregate counts, but named providers with named statuses. “We have 12 contracts in negotiation” is not useful. “Valley Orthopedic Group has been sitting unsigned for three weeks — here's why and here's what we need to move it” is useful.

4. Credentialing queue (10 minutes). How many files are in process, how many are complete and awaiting committee, how many are blocked on outstanding information, and what the next committee date is. This section should also flag any provisional credentialing windows that are approaching expiration.

5. Open issues and decisions (15 minutes). Anything that requires a leadership decision — a rate exception, a county adequacy waiver request, a staffing problem, a vendor relationship issue. The rule is that nothing that needs a decision stays on the open issues list for more than two weeks. If a decision is being delayed, the delay itself becomes the issue to address.

Who needs to be in the room

The weekly review requires decision-making authority in the room. That means the network management leader who owns contracting and credentialing, whoever owns the regulatory and compliance relationship, and a representative from finance if rate decisions are being made. The meeting fails when attendees can only report status and have to escalate every decision to someone who isn't there.

It should also include whoever is doing the actual outreach and credentialing work — not to present, but to answer specific questions about specific providers in the pipeline. The gap between what is reported and what is true often surfaces when the person who is actually making the calls is in the room.

The handoff to steady state

During the build, the weekly review is where the build is managed. After go-live, the same cadence continues — but the agenda shifts from build management to network maintenance. The adequacy section focuses on attrition and replacement rather than initial recruitment. The contracting section covers renewals and rate negotiations rather than new agreements. The credentialing section manages re-credentialing cycles rather than initial applications.

The cadence is not a build tool. It is a network management tool that happens to work especially well during a build.

When we hand a network back to an internal team, the weekly cadence is the most important thing we hand back. The team that can run the review — that knows what to look for, knows what decisions belong in the room, and knows when to escalate — is the team that keeps the network in compliance after we're gone. That is the outcome we are building toward.