Affordability and value: Why now is the time to embrace a high-performance, narrow network

Narrow network health plans, which leverage a smaller, select group of physicians and hospitals, are seeing a resurgence. The appeal of these plans is the focus on value.

To be part of the network, providers typically agree to lower payments from insurers, which can help control costs for employers and employees alike. When properly set up, narrow networks support coordinated care and provide access to doctors and facilities with measurable positive health outcomes.

According to a 2020 survey by Willis Towers Watson, 18% of large employers offer some type of narrow network plan to their employees. Expect that to grow. The Healthcare Financial Management Association reported in October 2020 that employers plan to expand use of narrow networks, noting, “Such networks have been hailed as a powerful tool to control cost increases and improve quality if providers are selected on that basis.”

The “if” is the key word in that sentence. Not all narrow networks are alike: All focus on affordability, but some fail to consider quality of care.

That’s why many employers prefer a “high-performance” network. High-performance networks, a type of narrow network, maximize healthcare value. The value comes from providers who consistently deliver high-quality, affordable care that is patient-centered, evidence-based, appropriate, and coordinated. Combining smart technology and exceptional healthcare provides lower overall costs for everyone while increasing access to care and treatment options.

All of this aligns with a value-based care model, which focuses on preventive care, overall patient health, and reducing waste. This approach pays doctors and hospitals based on the value of the care they provide, not merely the volume.

Transform your benefits plan with the right narrow network

Switching to a narrow network can be a big change for your employees. Here are some suggestions to ensure they have access to a plan that works for them and for your organization:

  • Determine whether the size of the network will provide the right level of access to healthcare for your employees.
  • Find out whether network providers are near where employees live and work.
  • Ensure that network providers are transparent about fees.
  • Look at the network’s quality data; consider using the National Committee for Quality Assurance’s report card.
  • Ask which tools are available to engage and support your employees.
  • Make sure the provider directory is easy to use and up to date.

Soon, you won’t have to ask about many of these items, as they’ll be mandated by the Consolidated Appropriations Act and Transparency in Coverage rule from the U.S. Departments of Health and Human Services, Labor, and Treasury. Many provisions — which will be phased in through 2024 — are designed to increase transparency.

These changes will help empower your employees to make more informed choices about their health and wellness.

Integrating with the healthcare ecosystem to improve outcomes

Combining a high-performance network concept with a comprehensive benefits design with digital capabilities begins with a carefully curated network of doctors and facilities, but it doesn’t end there. That’s because the future of healthcare is integrated: a thriving, interconnected ecosystem fed by data and supported by digital technology. All aspects of healthcare — doctors, health plans, wellness tools, and actionable information — must work together.

Relying on narrow network providers and the most sophisticated digital tools, cohesive care solutions like Anthem Link drive better patient outcomes and lower costs for both employers and employees. As an employer, access to transparent pricing information, tools to track network performance, and communications resources to engage and educate employees are top of mind. Employees benefit through connections to simpler, more effective, and more affordable care, and like you, they have complete price transparency.

An integrated, digital-first system also enables better provider collaboration and care coordination, and the ability to share data across the care continuum leads to stronger patient engagement. Patients can:

  • Assess symptoms online, find in-network doctors, and schedule appointments 24/7/365.
  • Find customized health coaching and wellness programs.
  • Engage in a comprehensive and personalized care model that supports them throughout their entire care journey.
  • View all medical records and health history in one place.
  • Review claims and benefits anytime.
  • Learn how much they’ll pay for care.

Anthem Link supports all this through sophisticated information technology. Clinicians can make stronger, individualized care decisions informed by artificial intelligence. A fully integrated ecosystem connects every point of interaction to every stakeholder, providing members with the support and care they need, whether in person or virtually. This convergence of people, tools, and innovation helps drive engagement, control costs, improve outcomes, and enhance the employee’s total health journey — all of which increases the value of your benefits offerings.

If you’ve been considering a high-performance narrow network plan for your company, now’s the time to make the switch.

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