To identify the benefits and detriments of choosing provider-led network healthcare coverage over a larger health system for healthcare to inform the client's understanding of the value propositions of each type of healthcare option.
Benefits of Provider-Led Healthcare Options
Provider-led healthcare networks offer benefits to both the provider and to the users of the healthcare options. The data integration of these systems allow for more centralized and focused care for each patient, which decreases hospitalization and readmission rates among patients, as well as decreasing Medicare-related costs. Additionally, member satisfaction rates have shown to be higher for provider-led healthcare options, in large part due to “reducing friction points for members though greater coordination of care.
For the providers themselves, integrated health records and care implementations/plans provide improved financial performance through increased efficiencies and reduced need for additional care in some patients.
A study detailed in the American Journal of Managed Care comparing “healthcare quality, utilization, and patient satisfaction between provider-led health plans (PLHPs) and non-PLHPs” found that provider-led health plans were associated with increased patient satisfaction ratings and increased effectiveness scores. Notably, no differences were noted in “access, discharges, inpatient days, and readmission probability.” PLHPs also saw lower rates of medically-necessary procedures than non-PLHPs had.
Benefits & Drawbacks of Narrow Networks
Provider-led healthcare plans are “considered a type of narrow network” because these networks utilize their own facilities, thus saving money. Between 2014 and 2017, the number of provider-led plan available on public exchanges increased 4%. Consumers who utilize these networks understand that they are trading fewer options for their care in exchange “lower monthly premiums and out-of-pockets costs.”
Experts note that benefits of narrow networks include: significant cost savings to patients, improved health outcomes due to continuum of care, and fewer trips to the emergency room because they have increased access to regular care.
Some of the drawbacks of narrow networks include a lack of consumer knowledge of care available in their areas or as needed, limited options for selecting doctors or other providers, and the distinct possibility of losing a doctor a patient has seen for years if that provider is not with the new plan.
PROPRIETARY DATABASE SEARCH
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