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How provider networks help lower health care costs

Originally published in The Tennessean, November 2021

Every year during open enrollment for health plans, many people have questions about their provider network options.

You may ask, how can I ensure my doctor is in the network I prefer? What are the differences between networks designated by a letter? And while we’re at it, why are these networks important to my health and my finances?

Health insurance can be a complicated industry, but it’s built on simple concepts. The network concept is no exception:

  • Health care providers accept lower rates for their services but gain access to more patients.
  • Health plan members access the network providers and get the benefit of the discounted rates for care.

You can find out if your doctors are part of certain networks by either using a “Find Care” tool on your insurer’s website or calling the doctor’s office and asking a staff member.

Know your letters

At BlueCross, network P designates our largest commercial network. Network S designates our slightly smaller network, which is lower priced than P. Both offer broad provider access. BlueCross has a new option for 2022, Network L, which I’ll discuss shortly.

When choosing a network, everyone wants to know, “What’s my yearly/monthly cost?” and “Will I have quality providers in my network?” Insurers put requirements in place to ensure their members get care that meets clinical quality standards.

BlueCross rewards providers for meeting or exceeding those standards. More than 80% of primary care providers in our networks participate in a “pay for quality” program — and most of our hospital contracts have quality benchmarks built in, as well.

Again, this concept is simple. Evidence-based care, whether it’s preventive or acute, leads to better health, better informed and empowered health care consumers , and better savings in the long run.

That’s why our medical policy standards include broadly supported practices that lead to better health for all our members, and why we require prior authorization for certain procedures, services and medications. Investing in quality performance is just as crucial as pursuing the best possible prices for care. 

We invest in quality health care, and we know our members do, too. Sometimes even after carefully selecting a health plan, many of us struggle to make time for our preventive care needs. The danger here is that a perceived lack of immediacy may put us at risk for long-term health complications.

Receiving quality care on your schedule

In order to further a commitment to preventive care, one must understand convenience and expanded access to care matter. That’s why BlueCross partnered with Sanitas in 2020 to open eight primary care clinics in underserved areas in Tennessee, starting in the Memphis and Nashville areas.

These clinics make access to primary care more convenient for all. We see this as a new model of care, one based on providers building relationships and staying engaged with patients after they’ve visited a Sanitas clinic, often through telehealth services.

Health plan members see cost savings when they receive care from in-network providers. That’s why all Sanitas clinics are within our networks, including our new lowest-cost option, Network L. This network includes many high-quality providers and is available to individuals who buy their own coverage, as well as small employer groups. This new option in Memphis and Nashville offers access to quality care and enhanced coordination of care as a way of lowering overall health care costs.

Convenience of receiving care and establishing trust within these communities are key for these clinics , but so is ensuring an affordable high level of quality. And health insurers like BlueCross keep costs low for patients through our provider networks.

About Clay Phillips, Vice President, Provider Programs and Strategy

A photo of the authorClay provides strategic leadership in developing and implementing provider networks and leads the company's efforts to evolve provider payment and care delivery models in ways that support better health and cost-effectiveness for our 3.4 million members.

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