Assessing High Performance Networks
If you were hiring a new employee, how would you identify a high-performing candidate during the interview process? Would you simply hire the candidate willing to work for you at the lowest rate? Probably not. You are likely to be more interested in a competitive candidate who has a proven track record of delivering the best results.
The same holds true in healthcare when defining a high-performance network. All too often, provider networks are labeled “high performance” when they are structured solely based on the lowest cost. That’s like building your whole company by hiring the cheapest employees you can find. Sure your overhead might be low, but by sacrificing quality, you end up paying more in the long run.
Given that managing healthcare cost is a top priority for many employers, it’s not surprising that high-performance networks are gaining a great deal of attention. To make the right decision for your business, you should have a clear understanding of what high-performance networks are— and what they aren’t.
A network that only includes providers demonstrating lower costs, like a lot of narrow networks, is not a high-performance network. Providers in a true high-performance network consistently deliver both lower costs and higher quality through care that is patient-centered, evidence-based, appropriate and coordinated. Robust data-sharing and effective quality measurement play a critical role, as well, in identifying providers delivering quality care at a lower cost. Quality standards for the network should be well-defined, rigorous, and derived from sufficient data in order to drive performance delivering quality outcomes and making a substantial impact on healthcare spend.
Today, roughly 15% of larger employers have built a “high-performance” network into their health plan1. This number is projected to grow in the coming years as these networks evolve and mature. However, given that not all high-performance networks are created equal, it’s important that you ask your health plan partner how quality and cost measures are factored into any high-performance network you are considering for your organization.
Identifying high performance is ultimately more about getting a positive long-term return on your investment—and that’s true whether you are hiring staff or choosing health benefit networks. Is there a proven track record of success? Is the rate competitive? Are you likely to get the results you are looking for? And most importantly, will you be happy with your decision in the long run? In order to identify a true high-performing option, the answer has to be yes for all.
By Jennifer Atkins, Vice President, Network Solutions, Blue Cross Blue Shield Association
1. Kaiser Family Foundation Employer Health Benefits 2017 Annual Survey