High-performance networks (HPN) include only top quality clinicians and provider organizations offering cost-efficient care that improves health outcomes.
In exchange for better care at a lower cost, employees have an elite pool of select providers from which to choose. However, McKinsey’s market research has found that when consumers are exposed to a simulated exchange environment and then asked to select their own health benefits, up to 80 percent of them are willing to trade access for a lower premium.
But not all narrow networks are high-performance networks. Though many include lower-cost providers, they don’t necessarily include high-quality providers. A true high-performance network delivers both lower costs and higher quality.
Moreover, not all HPNs are created equal. These five criteria can help you evaluate these networks.
How Employers Can Evaluate an HPN
High-performance networks (HPN) are a type of narrow network that include only top-quality clinicians and provider oganizations offering cost-efficient care that improves health outcomes. But not all narrow networks are high-performance networks. Though may include lower-cost providers, they don’t necessarily include high-quality providers. A true high-performance network delivers both lower costs and higher quality.
Five Evaluation Criteria of HPNs
Employers are increasingly turning to high-performance networks (HPN). These elite teams of providers deliver quality and affordability for you and your employees.
- How is quality defined?
- How is quality measured? Is it consistent? Is it transparent?
- Are the local quality metrics part of the quality reporting?
- Is the rate demonstrably better than that of the PPO option?
- How transparent is the cost reporting?
- How are the projected savings calculated?
- Are out-of-pocket costs lower for members?
- How will your employees be covered when they are outside of the HPN service area?
- How are other out-of-network services covered?
- Is it set up as an exclusive provider model (EPO), or is it tiered?
- Are the providers included in the network located near where your employees live and work?
- Are telehealth options available?
- Does the network include the facilities and specialists your workers need?
- Does this network have national coverage or only available in select markets?
- Does HPN provide distinct and differentiated member experience from PPO?
- What tools exist to help navigate and engage members?
- Is the provider directory easy to use and up to date?
- How members are educated and engaged during open enrollment?
We understand the complexities involved in choosing the right health care plan and want to provide employers with the solutions to make the best health care decisions for their company and employees.
To learn more about Anthem’s high-performance network solutions, contact your broker or Anthem account representative.
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*Of the 255 U.S. employers responding to a Willis Towers Watson survey, 65% said they plan to include high-performance networks in their health plans by 2020. Only 28% had such networks in 2017.