What Self-Funded Employers Should Ask About Their Provider Network

How Are Providers Selected for the Network?

Some provider networks are built to include as many providers as possible, while others are designed to emphasize cost and value.

Employers should ask how providers are evaluated before selecting the network:

• What criteria are used to select providers?
• Are providers evaluated for cost, quality outcomes, or patient experience?
• What are the performance standards providers must meet?

Some employer-focused network models take a curated approach to provider network design. For example, The Alliance works with providers and employers to identify providers that deliver great care at lower prices (Preferred-Value Providers).

How Does the Network Address Healthcare Cost Variation?

The cost for the same schedulable procedure can vary dramatically depending on where employees receive care.

For example, the price of an MRI, colonoscopy, or outpatient surgery can differ by thousands of dollars between providers, even within the same geographic region.

Employers should ask:

• Does the network analyze price variation among providers?
• Are lower-cost providers identified (Preferred-Value Providers)?
• Are employees encouraged to use those providers?

Networks that highlight Preferred-Value Providers can help employers reduce healthcare spending without restricting care.

Are There Preferred-Value Providers and High-Value Healthcare Options in the Network?

Many self-funded provider networks include Preferred-Value Providers, centers of excellence, or other high-value healthcare options.

These providers typically meet defined standards for:

• Quality outcomes
• Cost efficiency
• Patient experience

Employers should ask whether their network includes these types of designated providers and how they are communicated to employees.

These strategies can also be reinforced through benefit plan design. Steering and tiering encourage employees to choose Preferred-Value Providers by offering lower out-of-pocket costs or cash incentives when employees receive care from these providers.

When implemented effectively, these models can help employees make better decisions while lowering overall healthcare spending.

How Can Employees Find the Right Provider?

Even the best provider network will struggle to deliver results if employees don’t understand how to use it.

Healthcare decisions can be confusing, especially when employees are dealing with illness, stress, or urgent care needs.

Employers should ask whether the network provides tools that help employees navigate their options, such as:

• Online provider search tools (like The Alliance’s Find a Doctor tool)
• Cost comparison tools (like our Smarter Care Advisor)
• Quality ratings or provider performance indicators
• Educational materials explaining when and where to seek care

Clear communication helps employees become better healthcare consumers, which benefits both the individual and the health plan. Employer-members of The Alliance can reach out to your Account Executive for access to educational resources like our Better Healthcare Consumer packet.

What Happens When Employees Already Have a Trusted Provider?

Employees often worry about losing access to providers they already know and trust. Employers should understand how the network handles these situations.

Networks can contract with providers upon request, especially if multiple employees have an established relationship with that provider. The Alliance regularly contracts with providers based on employer requests, especially behavioral service providers. This approach helps ensure continuity of care.

How Are Providers Selected for the Network?

Access to care is another critical consideration. Even if a provider is technically in-network, long wait times or limited appointment availability can prevent employees from receiving timely care.

Employers should ask:

• Are there enough providers in key specialties?
• How does the network address provider shortages?
• Are telehealth options available?

Networks that actively recruit providers or work with employers to add requested providers can help address these gaps. The Alliance consistently adds new providers to increase access to high-value healthcare.

How Is Network Performance Measured?

Like any part of a benefits strategy, provider networks should be evaluated over time.

Employers should ask what metrics are used to measure network performance, such as:

• Cost trends
• Quality outcomes
• Utilization patterns
• Employee satisfaction

This information can help employers understand whether the network is delivering value and identify opportunities for improvement.

The Alliance provides a customized report (Smarter Health^SM analysis) to our employer-members detailing employee utilization patterns and cost trends.

How Does the Network Support Long-Term Cost Management?

Healthcare costs continue to rise, and provider networks play a key role in long-term cost management.

Employers should consider whether their network strategy supports:

• Use of preventive care
• Steering toward Preferred-Value Providers
• Reduced unnecessary variation in care

Collaborative models, including employer-driven networks like The Alliance, often emphasize transparency and partnership between employers and providers. This approach can create opportunities to align incentives around better outcomes and more sustainable costs.