Today there is more complexity than ever among health plans and the specialty solutions bolted onto them. In light of steadily rising health care costs, plan designers are searching for creative ways to build quality offerings, keep costs low, and simplify the member experience. The evidence is everywhere that current models are not working: Take the Amazon-Berkshire-JP Morgan announcement earlier this year.
While employees have become accustomed to the breadth of providers in a traditional open access network, it is not a very cost-effective option. Employers have been shifting the cost burden to enrollees, with collateral consequences, including deferring care – not our objective! Broad networks struggle with effective medical management, often employing a constellation of third-party specialty vendors that lack coordination within the broader portfolio, adding cost and complexity, and with debatable savings and quality impact.
Narrow networks have grown in popularity because their lower premiums make them more affordable. But this is primarily a discounted fee-for-service play using restricted choice. Employees have been hit with surprise out-of-pockets costs when they go to in-network hospitals because certain providers, such as anesthesiologists, are out-of-network. Some patients find out that a hospital or doctor was out-of-network only after they receive a shockingly high bill. There is dissatisfaction with narrow networks where care coordination is still not handled well, and the member experience is spotty.
There is another option, one that lowers costs, really coordinates quality care, and provides a choice of providers that employees want: an integrated network of hospitals, doctors, and other providers who are part of the same health system. Health systems agree to negotiate lower fees to attract a large number of employees who commit to their network for the entire plan year – leaving employees more money in their paychecks and providing a concierge-like member experience.
In an integrated health network care is coordinated, efficient, evidence-based, and supported by state-of-the-art information technology. Since providers in the health system use the same electronic medical record (EMR) system, doctors can more easily collaborate and share data. When a patient shows up in the doctor’s office, the doctor has a complete medical history – all checkups, lab results, x-rays, drugs prescribed and diagnoses made resulting in more coordinated care and better health outcomes. And, redundant medical services are not performed.
Since employees choose a single health system and commit to it for the plan year, they are more engaged in their health care decisions. They develop long-lasting, more satisfying, and clinically valuable relationships with their doctors. Employers benefit from a model that promotes better outcomes, long-term health, and productivity. All at lower cost for all parties. Choice is nice, and yes, an enrollee gets their care within their chosen health system. But how often does an enrollee really access care far afield? The reality is, care is almost always secured and delivered locally. Integrated networks are a growing and viable option.