Building a Narrow Network that Providers and Patients Will Love

by Luis Castillo on May 31, 2018

doctor holding a red stethoscopeWe need to talk about narrow networks. With healthcare costs escalating, payers are looking into every possible avenue to ensure profitability. As a result, the idea of the narrow network has grown in popularity.

Insurers no doubt want to steer their covered patients toward those facilities that strike the perfect balance between affordable rates and exceptional care. But this emphasis on the narrow network is not without controversy.

Patients, even when they’re saving money on their healthcare, don’t relish the idea that a payer will tell them where they can and can’t receive their coverage. And sure, insurers don’t necessarily tell a patient that they can’t visit a certain provider, but when the price for out-of-network coverage is so high as to be unaffordable, that’s tantamount to the same thing.

As a payer, your challenge becomes developing a narrow network that protects your profitability while ensuring providers and persons under your coverage are satisfied. Here are some tips on achieving that goal.


Explain the Benefits to Patients


When partnering with healthcare providers, one way to mitigate potential dissatisfaction is to explain to patients how the narrow network concept actually holds providers more accountable for outcomes.

The health systems you’ve partnered with for coverage will have a vested interest in providing optimum care that goes well beyond the moment the patient leaves the hospital. This is especially so if they’ll be working together with post-acute providers and technology companies to track the patients’ progress and ensure there’s no readmission beyond the 30-day window.

This is good news for patients, because providers will do everything they can to get the person healthy and ensure they don’t come back to the facility within that timeframe. What’s more, because lower rates have been negotiated, this savings will get passed on to the patient.

You need to explain these benefits clearly and concisely through messaging. Rather than focus on the providers that a patient won’t be able to see, which starts you at a negative point, highlight the value added by those providers that are in-network.

Physician profiles, tip sheets, insurance portals that connect patients to providers via telemedicine and same-day appointment scheduling; these sorts of things can take the sting out of a patient being required to switch doctors under your coverage.


Develop Partnerships in the Post-Acute Space


Narrow networks don’t have to be confined to acute care facilities.

In fact, narrow networks perform best when membership is extended to facilities that demonstrate viable positive outcomes in the post-acute setting. It’s in your best interest, and that of your patients, to work with post-acute care providers to negotiate terms and provide patients with a next step for when they leave the hospital.

My organization recently conducted a payer survey with the help of HIMSS Media that found six out of ten payers have gone down this path, either through a narrow network or a preferential contract. Many insurers have clearly already begun to see dividends, but that still leaves 40% who haven’t explored partnerships with post-acute providers.

Creating and managing your narrow post-acute network has multiple benefits. You save on cost because of the preferred provider relationship you negotiate with the PAC, just like you would with a hospital. Plus, you can tie payment to outcomes, ensuring your partner facilities have even more incentive to provide the best care possible to patients.

Your preferred hospital partners benefit from your post-acute narrow network as well. They’re basically receiving assurances from you that X, Y and Z post-acute providers give patients the care and clinical capabilities they need to prevent readmission to the hospital. It also saves hospitals time if, when showing patients their choice of discharge locations, they can highlight preferred, in-network partners that meet all the criteria the patient requires.


Supplement Your Narrow Networks with Tech


Once you’ve built out your narrow networks, you can begin to optimize care by investing in technology that assists the patient’s recovery.

Technology is the crucial final piece of the puzzle, the part that allows providers, both acute and post-acute, to communicate with one another to monitor the patient’s vitals and relay necessary information to the parties that need it most.

Software enables you to relay important communications to the providers and patients themselves. When everyone gets on the same page with an interoperable system that disseminates details to the appropriate parties, the risk of a costly error is reduced dramatically. What’s more, you can check in with your partner providers at regular intervals to make sure targets are hit, that patients are showing up to their scheduled appointments and that the ideal plan of care is being followed.

Technology also opens up a potential negotiating opportunity that ultimately results in better patient care overall. With the right software tools, you can quickly see which post-acute facilities are only taking on low-risk patients versus those willing to take on more risk, either in terms of the patient’s condition or their insurance (or lack thereof). This information compiled and readily available is very valuable, and you can use it as a crucial bargaining tool for facilities hesitant to take on high-risk patients. In turn, this allows you to build a network of trusted partners that work toward getting patients sent to the facility they belong based on their care parameters.

This acts as a crucial bargaining chip for facilities hesitant to take on high-risk patients. By identifying trusted partners, payers have more power to set appropriate rates and encourage other facilities to invest in the very same infrastructure that allows them to take on more risk while simultaneously increasing their financial benefit.


Narrow Networks and You


The trickiest part of the narrow network is getting buy-in from all parties. But by allaying patients’ fears, looking beyond acute care providers to partner with PACs and by harnessing technology to enhance the network itself, you can build a narrow network that wins the hearts and minds of everyone involved.

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Meet the Author

Luis Castillo has more than 30 years of experience in healthcare information technology. Prior to joining Ensocare, Castillo served as senior vice president at Siemens Healthcare, where he was in charge of IT sales, service and marketing. He was responsible for developing alternate markets, sales strategies and sales channels in order to grow the healthcare information technology business. Luis’ broad and deep experience has served to hone his leadership skills and business acumen, and he is a sought-after participant in strategic initiatives and global partnership efforts. He earned his Bachelor of Science degree in political science from Haverford College in Haverford, Penn.