Must-do strategies: All paths lead to value-based care 

It’s time to get on board. Historically, employers have favored broad networks to avoid disruption, but – done right – value-based care is not a take-away. It is the path forward to provide access to quality providers, drive better outcomes, enhance the member experience and make the best use of your health care dollars. 

The combination of rising health care costs and employers’ reluctance to shift costs to workers will drive interest in network strategies focused on value-based care: High-quality care delivered in the most cost-effective setting, producing the desired outcome – better health. There are many paths to value-based care, such as Centers of Excellence (COEs), Expert Medical Opinion programs, and navigation and advocacy services. In this post, we’ll focus on one of the more comprehensive approaches – high-performance networks.

New era of high-performance networks

Over the past few years, we’ve seen significant growth and evolution in high-performance provider networks, and today there are many innovative networks that are meaningfully different from traditional carrier narrow networks. While limiting the size of a health plan network might sound like a take-away, consider that in a broad network, you are offering both high-performing and low-performing providers and putting the burden on members to make a good choice. On the other hand, in a high-performance network you are offering only good choices – providers included specifically for the quality of care and outcomes they demonstrate. Given that offering a network curated based on quality improves the chances that your members will have a good healthcare experience, why would you not at least consider this option?

There are four general types of high-performance networks:

Carrier networks. These carrier-driven, pre-designed high-performance networks can be a complementary or replacement plan option for employers. They can be a straightforward option for employers that would like to offer a relatively broad, but still curated, network. Examples include Aetna APCN+, Anthem Blue HPN, Cigna Local Plus and UHC’s Choice Plus.

Vendor networks. Vendors contract with providers that meet specific cost and quality criteria, and offer stand-alone plans that employees must opt into at open enrollment. Savings are shared with employers and employees. This is an increasingly popular option, as vendors typically have more flexibility than a traditional carrier in selecting provider partners. Examples include Surest (formerly Bind), Imagine360, and Centivo.

Overlay networks. Vendors have strong analytics which they can use to identify a subset of high-quality providers from their broader network and create a high-performance network that is implemented on top of their existing plans. Members still have access to the broad network, but are steered towards the high-quality providers with incentives. Depending on the vendor, this approach could require significant employer oversight. Examples include Centivo, Garner, and Embold Health.

Custom networks or accountable care organizations (ACOs). Some large healthcare systems are willing to contract directly with large employers or an employer collaborative, forming partnerships to drive care within their system with the goal of managing care more holistically and achieving better outcomes. Employers can review quality and cost data for providers in a given market to select health systems and create a network. Employers can also develop value-based contracts directly with providers.

One challenge in moving to high-performance networks is that certain options are available in some geographic markets but not in others. But that needn’t be a deal-breaker. The best place to start is by exploring the many opportunities that do exist and evaluating them based on your priorities. Let your goal be to offer as much high-value care to as much of your workforce as possible now – and build from there.

This blog post elaborates on one of the six “must-do” strategies Tracy Watts shared in her post, 2023: The Year to Get Creative with Strategic Planning. Check out the other article in this series: Optimize Benefit Spend and Minimize Cost Shifting.