Efforts to improve the quality of care haven’t always achieved the parallel goal of cutting costs. Players in the value-based care space have developed alternative network types as one potential solution.
Sometimes referred to as “tailored” care, high-performance networks are intended to maximize health care value while maintaining affordability, and they usually cost less than the broader networks listed on the health insurance market.
Here’s what you need to know to decide whether a high-performance network is a good fit for you and your employees:
What Is a High-Performance Network?
In the 1990s, narrow networks emerged in response to the rising costs of health care. But, in many cases, these networks sacrificed quality care for their lower costs, and patients weren’t happy with the trade-off. In exchange for a lower premium, they had fewer physician options — fewer than a quarter of local providers in many cases, according to Consumer Reports. Ultimately, the limited choice, inadequate access to care and difficult pre-approval process associated with narrow networks led to patient dissatisfaction.
High-performance networks are a form of narrow network that emphasizes patient satisfaction. They can provide a better patient experience by increasing access to local hospitals, physicians and specialists that meet the patient population’s needs. This offers a high-value care delivery model with efficient performance at a lower cost — potentially 15 to 25% less than a traditional network, according to BDC Advisors.
High-performance networks often work with a larger organization to increase the number of available providers, chosen based on quality and cost-effectiveness.These factors are determined by a review of patient outcomes, claims data and other metrics relevant to the patient population they serve. For example, different metrics would be measured for a geriatric patient population than for a pediatric patient population. These metrics help drive performance by identifying at-risk patients and improving care coordination.
High-performance networks are strong complements to value-based payment arrangements, including how doctors may receive performance-based incentives and a focus on coordinated medical care. Being part of a high-performance network also requires a commitment to continuous improvement. Clearly prioritized financial and quality initiatives, information sharing and support are all critical to creating well-defined quality standards to drive performance and provide a collaborative approach to patient care.
High-Performance Networks and Your Employees
Employers may worry that a high-performance network will reduce the number and quality of doctors available, or that their employees might be upset if they need to switch providers. But though some benefits administrators have been reluctant to transition, 15% of large employers now offer a high-performance network as an option for their employees.
Employees with fewer health needs may not mind the loss of wider access to providers in exchange for more affordable premiums — as long as that transition is transparent. No one appreciates the surprise of discovering that the specialist they went to is out of network.
If you’re uncertain whether your employees will be happy with a high-performance network, take the following steps to ensure the network will help meet the health care needs of your employees:
- Check that the providers included in the network are located near your employees.
- Determine whether the size of the network might materially impact your employee’s health care choices.
- Ask questions to ensure that network providers are transparent about fees.
- Consider using the National Committee for Quality Assurance‘s report card tool to review the overall quality of the providers in the network.
This way, your employees can rest assured that they’re receiving top-quality care within their network and will know what to expect for out-of-pocket costs upfront.