High performance networks are attracting a lot of attention in the market today.
These are defined as networks that include providers who consistently deliver both lower cost and higher quality services through patient-centered, evidence-based, appropriate, and coordinated patient care. Beyond narrow networks, High Performance Networks focus on more targeted interventions, leveraging the expertise of the health system in the delivery of care and infrastructure like centralized analytics to focus on a disease state and optimize the care path. According to the American Academy of Actuaries, high performance networks tie the provider to both the upside and downside risk to ensure incentives are aligned between payors and providers.
The Blue Cross and Blue Shield plans are the latest to launch a national high performance network in an effort to curb the rapidly growing cost of healthcare in this country. Depending on health plan and region, these solutions can cut 10-20+% of cost, but a successful rollout depends on several critical items:
- Tools and Resources
The best way to optimize adoption and utilization of these networks is to influence the member shopping experience. With more than 80% of typical health plan member portal visits focused on provider and cost search, Sapphire’s digital and concierge services can help promote, communicate, and actively guide members to your highest performing providers.
- Risk Selection
Do you allow employers to offer a high-performing network alongside a traditional PPO? History has proven time and again that, given a choice, higher risk individuals and those who might lose their existing providers within the new networks will typically keep the traditional plan, which minimizes program savings.
Members have been used to the world of large PPO networks that include most providers and facilities. It’s essential to provide members with context and tools to help them understand the benefits of a high performance network to them and their families, so that they can feel confident about the level of care they will receive. Education > Understanding > Adoption
- Maximizing Value
Health plans and employers have the unique opportunity to educate their members on the fact that “all providers and facilities are not equal.” In addition to offering a high performance network provider finder, Sapphire can help health plans and employers promote the highest value providers that remain in these focused network offerings with digital promotion and redirection, concierge telephonic and chat-based service, and incentives to shop and choose high value locations for care.
As a strategic platform partner to our health plans, our role is to make sure we are supporting and enabling their business objectives and delivering on their organizational goals. Our CareSelect care navigation and member shopping platform is built to support all types of network designs including high performance networks. If you have any questions about our network configuration capabilities, please contact us.