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Answers to common provider questions about high-performance networks

Posted by Christine Murphy on July 14, 2021

Based on input from our members and employers, we created high-performance networks to support our mission of helping people live healthier lives. With any new product comes questions, so continue reading for insights from Christine Murphy, Vice President of Network Management at AllWays Health Partners to learn more about how these networks support our commitment to our community. 

As providers navigate rules, processes, and operational nuances with payers, it can be challenging when insurance companies introduce a new term like high performance network. Below, we explain the rationale for launching a high-performance network, and invite providers to share feedback about their experience with this option.

A more focused network allows for care circles to be reinforced by product design, not just physician practice pattern. The translation keeps more care in the system, allowing providers access to the care a member is receiving or not receiving, and identify care gaps. In addition to supporting our providers, AllWays Health Partners has launched high-performance networks for the following reasons:

1. Self-funded clients request these options

Our self-funded accounts, also known as ASO accounts, have a broader latitude to ask for customized products and networks. ASO accounts typically request custom benefit designs to meet the needs of their employees. More recently, our ASO accounts have requested that this customization broaden to include network design. This allows ASO accounts to offer products attached to networks that could be geographically limited. An example is a small company whose employees all live, work, and receive care in a defined geography.

An account may also want to tailor a network offering to emphasize a specific type of care. For instance, a trade union may ask that the payer emphasize chiropractic and acupuncture care. Or, the ASO account may want to offer a network whose relative rates meet some specific threshold for unit cost. Accounts rely on their own claims experience, CHIA data, and other sources to select which providers they want in and out of the offering linked to the product.

2. High-performance networks allow AllWays Health Partners to offer certain products on the Connector

We developed the Select network product to expand affordable options for our members to access high-quality care. This product will be available through the MA Health Connector, including to ConnectorCare members. Through the limited network, employers and members in 8 eastern MA counties will have access to comprehensive benefits and high-quality providers at a lower cost. This ensures that AllWays Health Partners makes healthcare access available to all individuals, regardless of their income.

3. To achieve the “quadruple aim” of Value-Based Care: enhancing patient experience, improving population health, reducing costs, and increasing satisfaction for the caregiver

In the value-based care world, networks have become an increasingly critical mechanism for directing care to the highest quality and value site of care. Network design can facilitate achievement of the quadruple aim by creating centers of excellence within networks, increasing referrals into a particular network with a given specialty, and allowing caregivers to form a deeper clinical relationship and understanding of their patients.

New high-performance network products meet customer needs at AllWays Health Partners

Our team launched two new high-performance network products in response to our unprecedented growth in the commercial market.

1. Allies HMO & Allies Choice
Designed to make high-quality care more affordable and accessible. Members will receive care at a top community hospital and get support from health navigators who ensure quicker access to care.

Visit our Allies page for providers and download the factsheet.

2. Select HMO
Select HMO members have in-network access to our new Select HMO network. Members will have access to comprehensive benefits at a lower cost through this network of high-quality providers.

3. Value HMO—coming in July 2021

In July 2021, AllWays Health Partners will launch a new network product that will have access to the Value HMO network. Members will have access to comprehensive benefits at a lower cost through access to a limited network of high-quality providers.

Visit our Select Network page for providers

For more information, please take a look at our product reference page.

Topics: Providers, Benefits, Employers

Disclaimer: The content in this blog post represents the clinical opinions of the providers at AllWays Health Partners and is based on the most currently available clinical and governmental guidance.

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