Balancing high-quality care for employees while trying to keep costs low is a challenge many employers face. But choosing the right options for your benefits plan can help you do both.
For instance, making sure employees can access in-network doctors and hospitals they trust and have lower-cost options is an important step.
How can you do that? It begins with getting to know your network options.
First, a network explained
As a quick refresher, a network is a group of health care providers who agree to provide services at a certain rate. It’s usually made up of primary care doctors, specialists, dentists, hospitals, and other health care facilities.
A network can be broad, with a large number of providers participating—like a national network. Or, it may be something known as a high-performing network, which focuses on delivering high-quality, affordable care.
In both cases, factors are in place to help plans and employees save money.
Your plan will work best for you when employees stay in-network. It’s the best way to save on costs, but is also the pathway to better, more coordinated care.
Understanding in-network versus out-of-network
So, why might employees choose an out-of-network provider instead?
Factors like proximity or availability can sometimes make staying in-network difficult. For instance, let’s say your employee needs to see a specialist. If there aren’t any close to where they live, they may choose the closest provider, participating or not. The same is true if employees need an appointment urgently—they may opt to simply see the first available physician.
But despite their reason, going out-of-network will likely cost employees more—sometimes thousands—in the form of copays, coinsurance and out-of-pocket costs. In addition, they may not get the same level of care from non-participating providers, which impacts health outcomes.
Guiding employees to better outcomes
To remedy these things, ensuring your health plan is outfitted with proper strategies can help you:
- Lower your own costs.
- Educate employees about lower-cost options.
- Guide employees to better higher-quality care.
- Improve future health outcomes.
- Make accessing the right care easier.
Solutions from Meritain Health®
And as we talked about above, health care solutions start with getting to know your network options. Our network options through Aetna® let you access over 1.6 million health care providers nationwide, including over 307,000 behavioral health providers. You also gain access to Institutes of Quality® (IOQ) and Institutes of Excellence (IOE) for bariatric care, cardiac care, orthopedic care and behavioral health.
Our broad network option—Aetna Choice® POS II network—gives you access to a full, nationwide network with carrier-level discounts. We’re the only third party administrator (TPA) able to offer this network.
Finally, connecting to tools and solutions from our preferred partners can enhance your network by expanding access, driving down costs—or both.
Some creative ones you may see are:
- Healthcare Bluebook™—our transparency solution helping plan members comparison shop for providers by cost and quality of services. Features an easy-to-use Fair Price™ tool and incentives through the Go Green to Get Green™ Program for making affordable choices.
- MinuteClinic® and HealthHUB™—walk-in clinics through CVS Health®, offering plan members a less expensive option than urgent care or the emergency room. Highlights include virtual appointments, 24/7 access and low-cost or no-cost options for everyday health needs or support.
- Edison Healthcare: guides patients to the best surgical and non-surgical treatments through a worldwide network of SmartCare Medical Centers. Second opinion services, a concierge travel program and care with fewer complications help with better outcomes and lower costs.
- ZERO Card*—helps employers make sense of claims data for smarter spending and more savings potential. Also, connects employees to a concierge-style personal health assistant for finding low-cost, quality health care providers as a no-cost service.
However, this is just the tip of the iceberg and a sampling of what’s available.
Contact your Meritain Health representative to learn more about fully getting to know your network options.
This article is for informational purposes only, and is not meant as medical advice.
*currently only available in certain markets