First, a narrow network plan is simply one where an insurer limits its members to certain providers. One or two networks may be offered. When two networks are available, they are usually called tiered networks, and plan members pay less when they use tier-one providers. Often, since “narrow network” doesn’t really reflect what these plans have to offer, insurers may call the network “preferred,” “enhanced benefit,” “high-value” “tailored,” or “enhanced value” to be more clear.
While narrow networks may be smaller than national networks, they are usually extensive and comprehensive, and patients gain a great deal because a narrow network is made up of low-cost, high-quality providers. According to the Kaiser Family Foundation, 15 percent of the insurance plans offered by employers offered in 2007 were narrow-network plans, and that number grew to 23 percent in 2013.
One reason narrow network plans are growing in popularity is because their premiums are usually lower. That’s because providers in the network offer greater value for the care they provide. Value comes from services that are lower in cost but high in quality. Quality is measured in many ways, and it includes data that reflects how well providers care for their patients and how safely they provide that care.
Narrow networks are also popular because these plans focus on integrated, coordinated care. The National Bureau of Economic Research studied a narrow network plan, and its findings suggested that the network did a good job taking care of its patients, because they saw their primary care doctors more and used the emergency room less.
Here’s an example of how these plans coordinate care. Consider a diabetic patient who gets admitted to a PinnacleHealth hospital for a serious health concern. Her PinnacleHealth primary care provider has access to her records and can contact the patient if she does not schedule a follow-up visit. At the follow-up visit in her primary care office, her care team can check her healing and help her address any aspects of her diabetes that could be managed better to avoid another hospitalization and help her feel better. If the patient needs additional services, the primary care team can coordinate that care and monitor her progress in her treatment plan.
Ultimately, a strong primary care relationship, receiving more preventive care and getting care in the right setting are some of the greatest benefits of narrow network plans for members. When the network comprises providers that are in the same health system or that are able to communicate with one another, it facilitates a team-based approach to care where health problems can be identified early and fixed before they become serious and expensive.
PinnacleHealth has been selected by several insurers to participate in tailored-network products because of our quality, safety and cost record. We’re pleased to work with these health plans and their members to provide an integrated experience that helps each patient get the treatment and services they need to get healthy and stay healthy in a personalized way.
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