High Performance Health Plan Networks

A Milliman report commissioned by AHIP finds that narrower, high value provider networks can help reduce premiums from 5 to 20 percent when compared to broad network plans. A high value network is one selected on the basis of not only fee schedules, but also overall efficiency and quality metrics. Health plans can make these judgments in ways individual consumers cannot.

It is ironic that ObamaCare has created the structure and incentives for a truly competitive health care market, something long sought by Republicans as an alternative to government regulation of prices and medical practice.

The Exchanges offer consumers an opportunity to compare plans on cost and (when the data are accurate and up to date) on networks. Now that insurance companies cannot manage costs by waiting periods and exclusions, they have more incentive to high performance networks as their main competitive advantage. This leaves excluded providers with the option to improve, and qualify for high performance networks, or lose business. Maybe, just maybe, we’ll see some improvement in the mismatch between what we pay for health care and what we get.


On Wednesday, July 23, join GHG to discuss the 2015 Medicare Advantage Marketing guidelines and how to plan for the upcoming changes. Register now >>

If you’ve just submitted your HEDIS data, now is the time to analyze that data for gaps and identify interventions for your health plans, providers and members. On July 17 join John Gorman, Executive Chairman at GHG, Jane Scott, Senior Vice President of Clinical Services and Anita McCreavy, Senior Consultant, for a webinar on HEDIS reporting, the new measures and what’s next. Register now >>

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