5 Signs It’s Time to Rethink Your Provider Network

Healthcare Costs Continue to Climb

Annual healthcare cost increases have become the norm, but that doesn’t mean employers have to accept them.

If claims costs or overall healthcare spending continue to rise year after year without measurable improvements in employee health, your provider network may not be delivering enough value.

High-performing networks help employers reduce costs by:

• Guiding (steering) employees toward lower-cost providers
• Encouraging the use of preventive care
• Reducing unnecessary emergency room visits
• Supporting chronic condition management
• Improving care coordination

Rather than simply providing access, the right provider network helps employees receive the right care, at the right place, for the right price.

This is important because when healthcare dollars are spent more efficiently, employers can reinvest those savings into richer benefits and employee wellness initiatives.

Lack of Price Transparency

One of the biggest frustrations employers face is not knowing what healthcare services actually cost until after the bill arrives.

In many cases, the same procedure can vary dramatically in price between providers, even within the same community, while delivering comparable quality.

Without meaningful price transparency, it’s difficult for employees to:

• Understand cost variation
• Compare providers
• Identify opportunities for savings
• Make smarter healthcare decisions

Transparency empowers both employers and employees to make informed decisions before care is received instead of reacting after costs have already been incurred.

The best provider networks offer tools that make healthcare pricing easier to understand and support informed decision-making throughout the care journey. The Alliance’s Find a Doctor and Smarter Care Advisor^SM tools help employees find and compare in-network providers and procedure costs to make the best decision for their healthcare.

Employees Aren’t Using High-Value Healthcare Options

Offering access to high-value healthcare options is only part of the equation. If employees don’t know where to find Preferred-Value Providers or the benefit of choosing them, they will continue to seek care from providers they are familiar with.

Preferred-Value Providers deliver great care at lower costs. When employees use these providers for common services like imaging, colonoscopies, laboratory testing, and outpatient procedures, employers can significantly reduce healthcare spending without sacrificing quality.

However, many organizations discover that utilization remains low because employees:

• Don’t know which providers are Preferred-Value Providers
• Don’t understand the financial incentives in their benefit plan
• Find it difficult to compare providers
• Schedule care with the provider they’ve always used

A strong provider network should include tools, education, and benefit plan design strategies that make choosing Preferred-Value Providers the easiest choice.

The Alliance Premier Networks offer employers the flexibility of a multi-tier benefit plan and is a great way to direct employees to low-cost, high-value providers without limiting their provider options.

Employee Engagement Is Low

Even the best benefits strategy can fall short if employees don’t understand how to use it.

Low engagement can look like:

• Employees not utilizing preventive care
• Limited use of cost comparison tools
• Frequent emergency room visits for non-emergency conditions
• Low participation in wellness initiatives
• Confusion about where to receive care

These behaviors not only increase healthcare costs but can also lead to poorer health outcomes and employee frustration.

An effective provider network should work alongside your benefits strategy to simplify healthcare decisions.

Clear communication, educational resources, and easy-to-use tools help employees become better healthcare consumers while improving their overall experience.

The Alliance creates educational resources that employers can share with their employees to get the most out of their benefit plan. Because when employees understand their options, they’re more likely to choose high-value options and avoid unnecessary healthcare spending.

You’re Not Getting Meaningful Reporting

Data should do more than summarize previous claims; it should help shape next year’s strategy.

Unfortunately, many employers receive reports that answer what happened without explaining why it happened or what to do next.

Meaningful healthcare reporting should help employers answer questions like:

• Where are healthcare dollars being spent?
• Which conditions are driving costs?
• Are employees using Preferred-Value Providers?
• Which services present the greatest savings opportunities?
• How effective are current benefit strategies?
• Where should we focus employee education?

The right reporting transforms healthcare data into actionable insights that support smarter benefits decisions. The Alliance’s Smarter Health^SM analysis provides a detailed customized healthcare analytics report that provides the foundation for a successful employee steering program.

With effective reporting, employers can proactively identify trends, measure results, and continuously improve their healthcare strategy instead of reacting to rising costs.