Health insurance

How provider networks help reduce healthcare costs

  • Clay Phillips is vice president of supplier programs and strategy at BlueCross BlueShield of Tennessee.

Each year, when registering for health plans, many people ask questions about the options of their provider network.

You can ask, “How do I make sure my doctor is on my preferred network?” What are the differences between the networks designated by a letter? And while we’re at it, why are these networks important to my health and finances? “

Health insurance can be a complicated industry, but it is based on simple concepts. The concept of a network is no exception:

  • Health care providers accept lower rates for their services, but have access to more patients.
  • Members of the health plan have access to network providers and benefit from reduced rates for care.

You can find out if your doctors are part of certain networks either by using a “Find Care” tool on your insurer’s website or by calling the doctor’s office and asking a staff member.

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Evidence-Based Care Leads to Better Health

At BlueCross, Network P refers to our largest sales network. S network refers to our slightly smaller network, which is priced lower than P. Both provide broad access to providers. BlueCross has a new option for 2022, the L network, which I will talk about shortly.

Phillips clay

When choosing a network, everyone wants to know “What is my annual / monthly cost?” And “Will I have quality suppliers in my network?” “

Insurers put in place requirements to ensure that their members receive care that meets clinical quality standards. BlueCross rewards suppliers who meet or exceed these standards.

Over 80% of the primary care providers in our networks participate in a “pay for quality” program – and most of our hospital contracts also have built-in quality criteria.

This notion is simple. Evidence-based care, whether preventive or acute, leads to better health, better informed and empowered healthcare consumers, and better long-term savings.

This is why our medical policy standards include widely supported practices that lead to better health for all of our members, and why we require prior authorization for certain procedures, services and medications. Investing in quality performance is just as crucial as seeking the best possible prices for care.

Convenience and expanded access to care are important

We invest in quality health care, and we know our members do too. Sometimes, even after carefully selecting a health plan, many of us struggle to find time for our preventive care needs. The danger here is that a perceived lack of immediacy can put us at risk for long-term health complications.

In order to continue a commitment to preventive care, it must be understood that convenience and expanded access to care are important. That’s why BlueCross partnered with Sanitas in 2020 to open eight primary care clinics in underserved areas of Tennessee, starting with the Memphis and Nashville areas.

These clinics make access to primary care more convenient for everyone. We see this as a new model of care, based on building relationships between providers and their engagement with patients after their visit to a Sanitas clinic, often through telehealth services.

Health insurance plan members save money when they receive care from network providers. This is why all Sanitas clinics are part of our networks, including our new cheapest option, the L Network. This network includes many high quality providers and is available to individuals who purchase their own coverage, as well as for small groups of employers. This new option in Memphis and Nashville provides access to quality care and better coordination of care as a way to reduce overall health care costs.

The convenience of receiving care and building trust within these communities is essential for these clinics, but so is ensuring a high level of quality and affordability. And health insurers like BlueCross keep patient costs low through our provider networks.

Clay Phillips is vice president of supplier programs and strategy at BlueCross BlueShield of Tennessee.

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