About WISHRM



Self Funding Partner General Provider Network...
Unsubscribe
Provider Network Design: A Key Driver of High-Value Health Care
by Kyle Monroe, Vice President, Network Development & Provider Relations

Today, we take an in-depth look into one of our four core driversprovider network design, and how it fits into the larger picture of high-value health care.

Employer-Powered Health Care

Not-for-profit purchasing cooperatives, like The Alliance, are recognized in the markets they serve due to their large member count and deep expertise in self-funding with a focus on data analytics, and cost and quality measurement. More importantly, they deliver a high-performing provider network that employers can use as a platform for benefit plan design by contracting directly with providers on behalf of employers to ensure high-quality, convenient, and cost-effective access to care for employees and their families.

Pushing Boundaries and Options

In an era where provider networks are getting smaller, The Alliance’s network is continually expanding to give employees and their families more options for care. Growing by about 30 more counties in just five years, it extends into Michigan, Minnesota, and Illinois. By continually monitoring where patients are seeking care and adjusting the network accordingly, members can avoid expensive out-of-network care.

Additionally, a partnership with Trilogy Health Networks provides members with services at hospitals and doctor offices that are not part of the primary network. This growth helps members’ expanding businesses, but also increases market leverage by serving more employers.

These initiatives go hand-in-hand with a shared effort to change how providers are paid (core driver two, payment reform) and focus on high-value primary care, often delivered through shared-site clinics. Employers use these tools to reduce their overall health care spend and employees are better served by primary care clinicians that can spend more time with them.

In other words, employers can offer enrollees a broader choice of high-quality, high-value providers while still seeing a reduction in cost. These solutions allow employers to drive down the total cost of care by aligning incentives and customizing networks regionally to maximize employers’ investments in health benefits.

What Can Employers Do?

Employers can work together by joining a purchasing coalition to control costs, add value, and expand their network and offerings. If you are interested in high-value primary care, provider network expansions, or our four core drivers of health care, feel free to reach out to us. To learn more about how The Alliance works with employers to make health care more affordable, contact our Business Development team.

Kyle Monroe joined The Alliance in 2017. His responsibilities include creating and maintaining relationships with health systems, clinicians, and other providers to support The Alliance’s strategic goals of improving high-value health care and leading new purchasing strategies. Kyle received his Master's of Business Administration in accounting and finance from the University Of Louisville College Of Business.
 
This post is locked to comments.
 

About Us

Chapters

News & Events


©2016 Wisconsin Society for
Human Resource Management Council
Wisconsin SHRM Council
2820 Walton Commons
Suite 103
Madison, WI 53718
Phone: (608) 204-9827
Email:  wishrm@morgandata.com
Join the Conversation


System Information - 141ms - 4.19