Hospital Impact—The upside of narrow-network insurance plans

Health insurance benefits form
Physician collaboration and established clinical protocols are made easier under narrow network plans built around a comprehensive provider network of highly qualified and trained providers. (Getty/michaelquirk)
Gwen MacKenzie
Gwen MacKenzie

With ongoing healthcare industry changes, it's likely that health insurance plans will continue to narrow rather than expand their networks of doctors and health systems.

But because larger networks result in higher costs, the increased prevalence of narrow-network health plans can actually be beneficial—especially as the industry shifts to value-based payment models.

The shift to value-based care is shaped by the idea that more fragmented care results in challenges to appropriate care delivery. Nationwide, disjointed care channels are preventing providers from reaching the quadruple aim: exceptional health outcomes, an exceptional experience for the people we serve, and an exceptional experience for providers, at an affordable cost.

The ability to truly execute the quadruple aim depends on having an individual receive care within a defined network. The advantage of more targeted choice in narrow network plans is that providers can deliver quality across the continuum of care while being responsible stewards of resources.

Eliminating fragmentation of care begins with a primary care provider relationship to help coordinate and facilitate the consumer experience. Without this preventive care access point to streamline the care delivery process, consumers of care are forced to navigate disconnected delivery systems.

When consumers are empowered to access integrated health systems by starting with a primary care provider, we improve the quality of care, increase convenience for individuals and create a more sustainable delivery system. It gives us the ability to provide the right care in the right setting at the right time.

Physician collaboration and established clinical protocols are made easier under narrow network plans built around a comprehensive provider network of highly qualified and trained providers. These plans operate within value-based contracts that direct consumers to participating physicians and hospitals.

One example in Michigan is a strategic partnership between St. John Providence, part of Ascension, and Priority Health, which aims to give individual market consumers access to high-quality care with significantly lower costs. The most notable benefit and distinction of this model is that narrow network plans offer members lower premium rates for their exclusive use of the provider network. These plans are becoming increasingly popular because they offer solutions without sacrificing the quality consumers have come to expect.

The benefits multiply for individuals involved in narrow network plans. Members who enroll in these plans receive coordinated care within one health system, along with services such as free health coaching, free virtual visits and care management for higher-risk patients with chronic health conditions.

We continue to evaluate care quality, cost and opportunities to improve care for those we serve. It is our mission to serve everyone who enters our care sites, with special attention to those who are poor and vulnerable. Participating in narrow networks supports our ability to carry out that mission in a sustainable way.

Gwen MacKenzie is the senior vice president of Ascension Healthcare and ministry market executive of Ascension Michigan. She provides strategic and operational leadership and alignment among health ministries within the Michigan regional market. She is also responsible for integrating the Michigan market with the strategic direction, vision and mission of Ascension.