Washington, D.C. – High-value provider networks are part of a broad array of strategies health plans use to maximize health care affordability and quality, and a new analysis
from actuarial firm Milliman for America’s Health Insurance Plans (AHIP) offers additional insight into how health plans develop these networks to improve care delivery and value. The report finds that high-value provider networks allow for more affordable coverage options with 5% to 20% lower premiums compared to broader network plans, while placing an emphasis on the quality and effectiveness of providers.
“High-value provider networks are an important option that families and individuals can select for access to affordable, high-quality care,” AHIP President and CEO Karen Ignagni said. “By partnering with providers to improve care delivery, health plans ensure patients get the best value for their health care dollars.”
To achieve high quality and cost-effective care, health plans’ high-value network designs are focused on delivering care through more efficient treatment protocols, which resulting in the elimination of wasteful spending. In that regard, these initiatives address the cost and quality challenges in a comprehensive way—not simply though implementing smaller or narrower provider networks.
While health plans continue to offer broader coverage options, creating high-value networks—or contracting with a select number of providers who meet quality, cost, and effectiveness metrics—is one way health plans address the wide variation in the price of services and care delivery. In addition, the report highlights that high-value provider networks are "specifically geared toward providing personal and comprehensive care to patients in an environment where providers effectively communicate and coordinate with each other regarding the best treatment for the patient.”
The use of high-value provider networks can help reduce premiums and promote more affordable coverage options for consumers—with premium reductions of 5% to 20% or more when compared with broad network plans.
High-value networks are developed through a deliberative evolution process considering more than just fee levels.
Active cooperation and collaboration—between the health plan and participating providers—is a hallmark of successful high-value networks plans.
Performance on quality measures is the key part of the criteria used for provider selection and inclusion in a plan’s network.
Integration of the value network into plan designs is being used to improve the efficiency of care management and quality of care.