The Importance of Your Health Plan's Provider Network

In healthcare, a provider network refers to the group of doctors, specialists, hospitals, and healthcare facilities that contract with a health plan to deliver care at pre-negotiated rates. These networks play a critical role in shaping both the cost and quality of care that members receive

Why the Provider Network Matters

The design and composition of a provider network influence the value that an employer and their employees receive. While broader networks offer access to a large number of providers, they often come with higher costs and limited oversight of provider performance. In contrast, high-performance networks (HPNs) are built around top-performing providers who consistently deliver better outcomes at lower costs.

To learn more about how networks impact healthcare value, watch this brief overview from Brian Wallach, Executive Vice President of Provider Networks:

Cost Implications

A common misconception is that larger networks automatically offer better value. However, most individuals only use a small portion of the available providers. Paying for broad access that isn’t utilized can lead to unnecessary expense. HPNs optimize for quality and cost by including providers based on outcomes, efficiency, and patient experience.

Quality Considerations

High-cost care does not always equate to high-quality care. Performance-based networks focus on measurable benchmarks, such as patient outcomes and readmission rates, to reduce avoidable procedures and costly complications. This results in better overall care and improved value for employers.

Customizing Your Network

Employers may identify gaps between their network and where employees seek care. In these cases, adding a specific provider through direct contracting may be appropriate. However, provider inclusion should be guided by performance data, rate negotiations, and strategic consultation. A qualified partner can evaluate whether adding a provider supports both cost and care goals.

Tailored Solutions for Different Needs

Healthcare Highways builds and continually evolves high-performance and custom networks that align with diverse employer goals, from broad access to targeted cost containment. Broad networks offer wide access; high-performance networks prioritize cost savings and quality. The most effective solution depends on the specific goals of the employer.

To evaluate your current network or explore available options, Healthcare Highways offers strategic consultation backed by over a decade of network development expertise.