What are High-Performance Networks?

Posted on: February 20, 2024

High-performance networks in an employer-sponsored health plan refer to networks of healthcare providers that have been selected based on their ability to deliver quality care at lower costs compared to other providers. These networks are designed to improve healthcare outcomes and reduce expenses for both employers and employees.

Here are some characteristics of high-performance networks in an employer-sponsored health plan:

1. Quality Metrics: Providers within high performance networks are often evaluated based on various quality metrics such as patient outcomes, patient satisfaction, adherence to clinical guidelines, and efficiency of care delivery.

2. Cost Efficiency: High performance networks typically negotiate discounted rates with providers in exchange for steering patients towards their facilities. This can result in lower out-of-pocket costs for employees and reduced overall healthcare spending for the employer.

3. Care Coordination: These networks often emphasize care coordination and integration among different healthcare providers. This helps ensure that patients receive appropriate and timely care while avoiding unnecessary services or duplicative treatments.

4. Network Transparency: Employers and employees are usually provided with information about the providers within the high performance network, including their quality scores, cost ratings, and patient reviews. This transparency allows individuals to make informed decisions about their healthcare providers.

5. Incentives for Utilization: Employers may offer incentives such as lower deductibles or copayments for employees who choose to use providers within the high performance network. This encourages employees to seek care from high-quality, cost-effective providers.

6. Population Health Management: High-performance networks often include population health management programs aimed at improving the overall health of employees and reducing the incidence of chronic diseases. These programs may include wellness initiatives, disease management programs, and preventive care services.

Overall, high-performance networks in Employer-Sponsored Health Plans aim to strike a balance between quality and cost-effectiveness while providing employees with access to high-quality healthcare services. Exploring their use is a valuable exercise in the employer’s attempt to control overall health plan spending and manage the employer/employee cost share.