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. 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.
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.
BRIAN WALLACH | Vice President of Provider Networks, Healthcare Highways
Mr. Wallach has more than twenty-five years of provider network management experience. His extensive experience and knowledge of provider network management comes from diverse roles such as planning and building provider networks at a start-up company like Oscar Health to managing Cigna Healthcare’s 90,000+ provider network in 18 states located throughout the southeastern U.S. to being responsible for network assessment, building and maintenance of the provider network around the globe for Cigna International. Mr. Wallach holds a Juris Doctor degree in Healthcare Law form the University of Houston. Read more of his industry insights here.