Care management

Breaking Down Narrow Networks: A Menace or a Mercy?

Abhinav Shashank
Tue 28 August 2018

Until fairly recently, broad networks were really common in healthcare- where a good number of hospitals and providers were considered in-network for one health plan. However, with the cost of care rising by the day, healthcare executives are looking into every possible avenue to ensure the value and quality of care are not compromised.

One way health plans and providers are trying to rein in the costs is through narrow networks.

What are narrow networks?

Narrow networks are comprehensive networks of providers in a restricted manner, agreeing to meet specific quality requirements and accept lower reimbursements. Narrow network plans are a viable alternative to broad-network plans that are usually accompanied by a hefty insurance. Basically, narrow networks are built with providers and hospitals that agree to deliver higher, measured quality of care and better outcomes.

The major objective of a narrow network is to steer patients towards a comprehensive group of providers that offer coordinated, quality care at a reasonable cost. Although narrow networks put greater restrictions on a patient’s choice of healthcare providers, they can offer higher value and quality care to their members. Additionally, having patients among a smaller group of providers and hospitals also allows payers to negotiate lower prices, which leads to lower premiums and out-of-pocket costs for members.

A study conducted by the Harvard Business School and Northeastern University found that narrow provider networks under ACA silver plans were 16% cheaper for members and offered payers a significant savings opportunity. Additionally, narrowing just one of the two types of network- physicians or hospitals- could produce 6% to 9% of savings.

So why aren’t narrow networks more popular?

Despite all their provisions and strengths, narrow networks can be unappealing to members because they limit a patient’s choice of healthcare providers. This is particularly challenging for patients living in rural areas. Many patients prefer to have the freedom to choose their provider and could possibly decide against enrolling in a narrow network. Also, it may be difficult to introduce low-cost narrow networks in uncompetitive markets.

How to create a narrow network that mitigates the challenges of healthcare?

Strengthen the care delivery process of the network

Narrow networks thrive on patient-centric care. Patients are put in a comprehensive network of providers to ensure the collaboration between providers is seamless and in real time. A network should ensure that its infrastructure is robust enough to ensure patient information sharing in real time, all over the network to help the patient navigate the care continuum easily.

Providers should be able to access updated information in real time, from any corner of the network and relay it back as well. Collaborative workflows for providers could be instrumental in managing multi-disciplinary teams associated with an individual patient. Additionally, automating processes such as work queues and task hand-offs could result in increased efficiency in care programs and less wait time for patients.  

Keep physicians engaged

The physicians are the drivers of any healthcare network. No less than 49% of a physician’s time goes into looking up patient information from their EHRs, putting it together with other sources, and updating information back in the EHRs. Physicians have to be delivered actionable information right at the point of care to help them form a better picture of their patients and interact with them better.

Critical information about the patient’s care gaps, dropped codes, due measures or screenings should be accessible to the physician- within the EHR. Physicians should be able to gain a better view of their upcoming appointments and the number of gaps that have to be addressed for each patient, synchronized before the start of their day. They should be engaged with the details of the network performance, the number of care gaps they closed, and their individual performance. Only a significant chunk of the information has to be delivered to the physician to reduce their workload and let them do what they do best- provide care.

Track the resources and their utilization

With a narrow network, it’s important to direct and keep the patient flow within the network. The healthcare executives at any narrow network have to ensure the network remains comprehensive and is capable to deliver all the care services to their members.

Executives of any narrow network should track the utilization of their services and monitor any out-of-network activities. The providers should drill down and try to identify the reasons behind any significant network leakages or activities such as high ED visits or high SNF admission. Additionally, the providers should regularly monitor their network’s performance against the quality benchmarks and take adequate steps to boost quality care in their network.

Supplement your narrow networks with tech

All of the steps mentioned above have an essential foundation- technology. A narrow network aiming to deliver value-based outcomes has to leverage the technology around them to strengthen their approach and maximize their outcomes. Technology will be essential in checking if the targets are hit, the ideal plan of care is being followed, and patients are connected.

To begin with, the network’s data– claims, clinical, lab, financial- can be a valuable asset to analyze the population health, assess the resources, and gather insights that could help create patient-specific care programs. The analysis can also be helpful in measuring the network’s performance and tracking the progress against quality benchmarks. The network should have a robust technology that assists them in integrating, updating, and sharing critical information in real time. Such infrastructure would also be instrumental in improving transparency and collaboration among providers and get everyone on the same page.

Engage and explain the benefits to patients

The most important of all- loop your patients in. The members of your network have to be engaged and they should be explained how a narrow network would actually hold providers more accountable for outcomes.

Patients should be given access to physician profiles and portals or apps where they can connect to their provider when needed. Smarter scheduling and well-established connectivity to simplify data sharing could also be helpful to save the patient’s time and streamline processes. Moreover, providers can run automated calls or texts to remind patients of their upcoming appointments, to follow up with them, and keep them engaged. The network providers can also loop in the patient’s caregivers and community care teams to plan the next steps when the patient leaves the hospital.

How would narrow networks impact patients?

True, narrow networks offer lower premiums and there’s a good number of people who might pick a network with lower premiums and it could be a good choice to provide care to people. However, for the 45% of Americans with chronic conditions, or the ones with fatal or rare conditions, narrow networks may not be up to the mark. In addition, many members have expressed dissatisfaction on account of unexpected charges and a skinny choice of providers.

But narrow networks employ a quality and patient-centric approach. The quality of care any healthcare network delivers is all about who they know they are treating. Assessing the patient population and creating a value chain that addresses the specific needs of the patients is what narrow networks should essentially have.

The road ahead

The trickiest part of the narrow network is assuming a patient-centric approach and making it happen. And narrow networks are much more than an emerging structure in a competitive landscape- narrow networks can be a significant example of being a high-performance structure that is able to control costs and improve quality. Whether or not they would be a good news for the patients is yet to be seen- but the key element of a narrow network is transparency and coordination among providers. And if that’s something all the networks can incorporate, we may have something to hope for. Boundaries are disappearing. The patients are becoming empowered. Perhaps very soon, excellence in care will be a way of life.

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