Employers select networks built for quality care and lower costs
More employers are choosing networks that promote quality care and cost saving — without sacrificing provider choice.
With health care costs rising, more employers are looking to networks as a means for managing their spend.1 In fact, a recent report showed that employers are interested in strategies that maintain broad networks and health plans that help their employees make more informed decisions around seeking higher-value providers.1
About one-fifth of employers surveyed relied on Centers of Excellence (COEs) and high-performance networks (HPNs) to help support their employees’ access to high-value care, and slow the growth of health costs.2 Larger employers seem to use HPNs and COEs even more, with 46% of surveyed employers with 20,000 or more employees having indicated that they use these types of networks.2
Nearly half of surveyed chief financial officers believe there should be a “very strong” or “strong” emphasis on networks that prioritize higher-value providers to better manage costs over the next 3 years.1
In other words, a growing number of employers see the value of quality networks that help manage costs while also meeting employee needs for simplicity, flexibility and provider options.
In other words, a growing number of employers see the value of quality networks that help manage costs while also meeting employee needs for simplicity, flexibility and provider options.
The networks that are becoming distinctive in the market are designed to:
- Maintain network strength and provider availability
- Support more effective access to care
- Reward providers for the quality and cost of care they deliver
- Incent employees to choose high-value care options
- Encourage the provider-patient relationship
Provider networks are on a continuum
Employers have a variety of choices when selecting provider networks for their employees. They can opt for broad networks that offer extensive coverage or high-value networks that focus on a select group of quality providers and facilities. Additionally, there are networks that rely on the employee’s primary care provider (PCP) to direct them toward appropriate care — as well as many variations in between.
Network designs, from broad access to focused access
- Broad open access - Employees have direct access to any network provider
- Open access - Employees have direct access to many providers in a slightly scaled down network
- Provider aligned with a referral - Employees select a PCP who coordinates care and provides referrals to network specialists as needed
- Broad ACO - Integrates value-based ACO contracts with value-based employee benefits
- Provider aligned - Integrates value-based ACO contracts with a focused network
Balancing the power of choice with quality and cost
Many employers and employees appreciate the flexibility and array of options provided by a broad access network. These types of provider networks are popular, especially among larger employers. In fact, 63% of large employers surveyed characterized the networks in their largest health plans as “very broad.”3
Offering a wide range of provider and site-of-care choices may improve an employee’s experience with their employer’s health plan, but it can also lead to decision fatigue for employees and variability in costs for employers.
That’s why it may be critical for carriers to pair broad access networks with health plans that feature a digital experience, allowing employees to view quality and cost information across different providers and sites of care. Giving employees convenient access to that information may enable more informed health decisions and potentially reduce the cost of care for them and their employers.
Encouraging the patient-provider relationship for better navigation and lower costs
PCPs may act as a health guide — someone who can help coordinate an employee’s care and support them in achieving better health. Arrangements like these help employees build stronger connections with their PCPs, which may help improve their health plan experience and impact the bottom line.
33%
lower health care costs for U.S. adults who regularly see a primary care physician4
For instance, employees who engage with their PCP may have better compliance with screenings and better outcomes. Employees may also find that navigating the health system is simpler, since PCPs can assist them and their covered dependents in accessing appropriate care at the right time and place.
When more complex issues arise, PCPs may be integral in prescribing cost-effective medications, making referrals to specialists and recommending appropriate sites of care. Point of Care Assist®, a tool that integrates real-time member information into existing electronic medical records, supports providers in their quest to provide their patients with quality care at the lowest cost.
“When members have a primary care physician, they tend to have a lower cost of care,” says Dr. Gerald Hautman, chief medical officer of National Accounts for UnitedHealthcare Employer & Individual. “And our research demonstrates that those members have a better experience because they’re able to navigate a complex health care system a little more easily.”
Prioritizing high-value care for more personalized, cost-effective support
When an employee population has complex health needs or is highly localized geographically, networks that offer more focused access may be a better fit. These types of networks provide employees access to quality care based on their unique health needs or situations.
In designing these custom network configurations, carriers often collaborate with local health systems and care providers whose goal is to deliver quality care at lower costs. For instance, UnitedHealthcare offers high-value networks in collaboration with select Accountable Care Organizations (ACOs), COEs and local health systems.
Collaborations with ACOs
ACOs are groups of doctors, hospitals and other health care providers who come together on a voluntary basis to provide coordinated care to the members they serve. They’re voluntarily making themselves accountable for the cost and quality of care they offer their patients — and they’re helping move the needle when it comes to managing costs. At UnitedHealthcare, through one ACO plan design, physicians and specialists evaluated for quality and cost efficiency generated up to 15% in savings.5
Collaborations with COEs
COEs, which are programs that help identify the best available care for complex conditions, may help manage the costs of large claims like cancer treatments. About 1 in 5 employers that offer health benefits offer a COE program — and of those, 45% offer a COE for joint replacement, 42% for back or spine surgery, 31% for bariatric surgery, 30% for mental health conditions and 28% for substance use disorders.6
COEs can help bring more accurate diagnoses, fewer readmissions and complications, reduced initial procedure costs and a simplified billing and payment experience..7 COEs may also offer the most important thing of all: higher survival rates and better outcomes.7
Local health systems
Different pockets of the country offer varying health systems, some with more options than others. That’s why collaboration with local health systems may be critical. For example, in areas where there are fewer providers or sites of care, ensuring that the networks are robust enough to serve members’ needs — or offer alternate options, such as virtual care — becomes even more important.
Selecting the right network design matters, and UnitedHealthcare is here to help
UnitedHealthcare is constantly evaluating its portfolio of networks to ensure employers have access to options that meet their needs and the preferences of their employees. This includes streamlining the number of network constructs offered and further investing in, evolving or expanding existing networks — to help make the selection process easier for employers, brokers and consultants.
A distinctive approach to the identification and designation of high-value care providers
Recognizing that not all providers deliver the same level of care, UnitedHealthcare uses standardized quality care criteria for effectiveness and efficiency to help members make more informed choices for their medical care.
“We’re helping members shop for health care like consumers shop for anything else,” Hautman says. “Giving members the information they need to make more informed health care decisions matters because it can translate to better health outcomes and a lower cost of care for those members as well as employers.”
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