Look beyond discounts to help clients see more value from their provider network

When it comes to health care, employers, patients, providers and health plans are all looking for the same thing: the right care, delivered at the right time, in the right setting and for the right cost.

Sounds simple. But in an industry as complex as health care, it’s not always easy. And the stakes couldn’t be higher for many of the country’s largest employers spending millions of dollars every year on health services. After all, achieving this goal consistently can mean not just the difference between a profit or a loss, but whether the firm will benefit from the competitive advantage of a healthier, engaged workforce. 

Enter the high-performance provider network.

High-performance networks feature health care providers who have demonstrated their ability to produce positive health outcomes at reasonable costs. Reducing cost and improving health care quality can result in value for employers and employees, and deliver many other benefits to stakeholders across the health care system.

During the past several years, there has been a dramatic proliferation in the use of high-performance networks to achieve these goals. Most health plans offer some version of a high-performance network product to their members. In fact, by 2019, 50 percent of employers with more than 1,000 employees are expected to use high-performance networks to achieve their objectives when it comes to delivering health services to employees.1

But not all high-performance networks are created equal – and not all have the data or experience to demonstrate their value. So, what makes the network strategy of one health plan a better investment than another? 

The question of price: Looking beyond discounts

Employers making critical decisions about health benefits want to see the value of their investment. When evaluating health plans, employers often look for a common point of comparison. For the overwhelming majority of employers, these data points take the form of “negotiated discounts.” 

However, discounts don’t measure the cost of an episode of care. Deeper discounts don’t necessarily mean lower costs for employers or better outcomes for employees, said Rick Viesta, chief actuary of UnitedHealthcare National Accounts. “Discounts do little to inform the true purpose of a health plan – which is to improve the overall health of employees and decrease everyone’s – both the employer’s and the employee’s – costs in the process.” 

Viesta placed the discount discussion in context, “What discounts fail to reflect are things like how health plans manage inappropriate lengths of stay, engage with their members, or direct care to the most efficient resources and sites of service that deliver the best outcomes at the best cost.” 

More directly, when it comes to benefit program decisions, employers shouldn’t be purchasing health plans or their network offerings based solely on discounts. 

The right data drive the right decisions

Instead, Viesta further explained, network design and participation require a more complete understanding of data, outcomes and trends. 

UnitedHealthcare has a sophisticated approach to network strategy that uses rich data sets and analytics to identify how provider networks are helping members slow disease progression. The data is used to inform consumer decisions as well, like using a quality designated physician who will give best practiced care, and understanding the value of checking in with our health advocates to understand treatment options, place of care and ranges of cost for episodes of care.  

When health plans and provider networks focus on delivering better care, improved outcomes and lower costs can be expected. UnitedHealthcare’s latest value-based care report shows that employer-sponsored and individual Accountable Care Organizations (ACO’s) are better on 87 percent of the top quality measures than non-ACO’s. In addition, UnitedHealthcare’s suite of high-performing network products saves customers an average of 3-10 percent in total cost.2

The UnitedHealth Premium® designated Premium Care Physicians program has been part of UnitedHealthcare’s network strategy for 12 years, making it the first in the market to effectively measure providers against benchmarks for quality of care and cost efficiency on a national and local scale. Leading this effort has paid off for employers and members. UnitedHealthcare data shows an average cost savings of 17 percent when comparing Premium designated and non-Premium designated providers.3

“We started this journey years ago, and it has helped us forge a path hand-in-hand with our consumers, employers and provider organizations,” said UnitedHealthcare’s senior vice president of client network solutions, Lisa McDonnel. “It gave us a unique opportunity to learn things like the importance of transparency with providers and consumer as well as aligning provider and consumer incentives with value, a framework that other health plans are now trying to replicate.”

Time will tell

Many of the recent network deals are taking a cue from -- or trying to imitate -- the integrated model UnitedHealthcare has made successful for more than a decade. The difference is that it will take those organizations many years to build up a critical mass of data comparable to the one UnitedHealthcare uses when determining the success of these new alliances.

“True integration and improved performance just don’t happen with the flip of a switch or the stroke of a pen. Instead it’s a long-term commitment that requires clear vision and intention. For example, our ACO partners appreciate the data we give them that enables them to optimize the care they provide to our members.” stated McDonnel. 

“Improving value isn’t just about changing the way we pay and work with providers,” she continued. “It has to integrate plan design and network configuration. It has to align the reimbursement incentives, clinical programs, support tools, and data sharing with providers and with employers.” 

And it has to go beyond that, she argued, to institute innovative products and tools that guide and engage consumers, making their experiences positive and useful so they’re incentivized to use the right services and providers at the right time. 

McDonnel pointed out that it’s one thing to identify the providers delivering better value but the ability to move volume to those providers is critical. For example, with the NexusACO™ product UnitedHealthcare offers access to ACO providers with proven results for delivering quality and efficient care and then lowers consumer out of pocket cost as an incentive to use those providers. 

In other words, network strategy has to be stronger and more forward thinking than just connecting providers. Network strategy has to be a long-term play that brings foundational provider relations, deep data along the entire care continuum, and proven, fully integrated systems together to drive consumers, and employers, to better care for better costs.

Employers can’t afford uncertainty

For more information, please contact your UnitedHealthcare representative. 

The UnitedHealth Premium® designation program is a resource for informational purposes only. Designations are displayed in UnitedHealthcare online physician directories at myuhc.com®. You should always visit myuhc.com for the most current information. Premium designations are a guide to choosing a physician and may be used as one of many factors you consider when choosing a physician. If you already have a physician, you may also wish to confer with him or her for advice on selecting other physicians. You should also discuss designations with a physician before choosing him or her. Physician evaluations have a risk of error and should not be the sole basis for selecting a physician. Please visit myuhc.com for detailed program information and methodologies.    

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