High-performance Network: What it is, Does & Why It’s The Future (Again)
admin | September 21, 2018
The High-performance Network : Old, Made New (Again)
A high-performance network offers a cost-effective solution to the continued rise of health plan premiums, while sustaining employee benefits. The adoption of health plans like Healthcare Highways that use high-performance networks is gaining traction. These carefully curated networks aren’t new. A decade ago they were common, but lost popularity to aggressively marketed broad networks. They began regaining market presence in 2014 under the moniker “narrow network” by bringing fresh solutions to the employers seeking to maintain healthy work forces affordably. Their combination of improved employee health outcomes and cost-effectiveness has increased the rate of adoption of high-performance networks over the past four years by 267%. Selection criteria for physicians in these networks vary but most include metrics around referral management, providing efficient care, and the provider’s demonstrated ability to produce positive patient outcomes.
Incentivize Outcomes, Not Output
Traditional networks rarely offer performance-based incentives to physicians. The typical fee-for-service model reimburses providers for the number of services they provide. High-performance networks reward physicians for delivering efficient, outcome-driven care that results in improved patient health outcomes. In exchange for a consolidated, high-performance network of quality providers, members and employers pay lower premiums. Members also have lower out-of-pocket costs. In addition to access to physicians with above-average performance metrics, members of high-performance networks often receive coordinated medical care, helping patients navigate their healthcare treatment options and maintain healthy lifestyles.
Improve Patient Health Outcomes and Reduce Total Cost of Care
High-performance networks can be a valuable foundation in a health plan when the benefit structure is designed to help members take full advantage of in-network services. Well-designed benefits that use financial incentives to keep members in-network also ensure that members are seeing providers who are known to align with a healthcare philosophy, for example, value-based care. Combined, these programs enable physicians, care teams, and members to work in tandem to:
- Facilitate the right care at the right time.
- Identify and direct clinical resources to high-risk patients, reducing the occurrence of costly health events.
- Ensure compliance with treatment programs for members with chronic conditions.
- Increase member adherence to preventive and prescription drug treatments, avoiding higher costs later as health conditions go untreated.
Carefully selected, high-performance networks deliver what employers need to quell inefficient care and rising costs, while increasing improved patient outcomes, strengthening the patient/PCP relationship, and empowering primary care physicians.
Follow Executive Vice President of Provider Networks Brian Wallach on LinkedIn.