Narrow networks are back in vogue with health plans, trying desperately to offer a lower cost product. A narrow network focused on maximizing discounts by partnering with limited providers is likely to fail in the long run.
For employers, this discussion needs to move away from ‘narrow’ to more about a care delivery model that provides the highest value and most efficient performance to their employees.
Such high performance networks (HPN) should combine desired market coverage with member focused care delivery models, and provide a strong foundation to move the needle on cost and quality.
Accountable care organizations (ACOs) are quickly evolving as HPNs that employers should explore. ACO is a health care system that partners with employer (or other payers and TPA) to develop a model that aligns financial interests with delivery of effective and quality care for specific population.
Why is it important?
No health plan can consistently deliver on cost, quality and experience if it does not have an aligned provider network. Traditional fee for service delivery system (such as PPO), is not aligned with employer or employee’s needs. The results of such misalignment is there for everyone to see.
A true ACO on the other hand can be aligned with employer’s specific interests and values, its geography, and provider, service, payment preferences etc.
What about multi-location employers?
If you have employees working in multiple locations, you may find it challenging to partner with each ACO separately. In that case, you may explore partnerships with a TPA that provide a layered network on top of these ACOs to deliver consistent quality and experience to employees dispersed over wide geographies.
What will be different?
Since ACO technology foundation is based on sharing data between providers, employers will get more real-time data about claims, admissions, readmissions etc.
Goals and Metrics