How You Perceive Network Discounts Matters

How You Perceive Network Discounts Matters
October 17, 2023 Sue Riordan
How you perceive network discounts matters

So much goes into achieving medical cost savings.

But in the industry, we often get so laser-focused on network discounts, we forget the relevance of building health care solutions that complement a plan in a way that can influence and manage the total cost of care. By combining the right network—one that is established, robust and has market-share strength—with other administrator solutions, like strong claim edit programs, high-dollar claim review solutions, outstanding claims integrity processes and best-fit benefit designs, plan sponsors can regain control over their total cost of care spend while improving health of their members.

We like to say network discounts are just one part of the story when it comes to achieving medical cost savings. The market competes based on discounts, but that’s really just the surface layer of how medical cost savings are achieved.

At Meritain Health®, we not only provide strength of network, but we have options to enhance your savings experience that go far beyond the discounts of the network. That’s why we ask as new network discount reporting standards emerge, our partners be vigilant in trying to understand what these are and why they matter. We’ve made changes that allow us to closely mirror how data is getting reported across the market. We encourage you to talk with us or to other industry leaders about the best data sources to look at, so you get the most accurate picture. We also put together this brief guideline to help.

How much are you really saving through your network?

Not all networks are created equal—nor is the way network discounts are reported. Discount tracking and reporting methods can impact how average discounts are interpreted. This can be misleading to even the most thoughtful plan sponsors and producers, so real transparency is necessary.

What’s happening in the market? Understanding network access and discount reporting

Meritain Health not only brings national broad network options, like Aetna Choice® POS II network, but we also have high-performance network options and can even customize your network design in certain situations. We rely on updated methodologies which align with how consulting firms and third parties manage our discount submissions.

To really determine network savings, it’s important to acknowledge how reporting may vary based on contracts, data selection and reporting periods. This may lead to a variation in benchmarking data, creating less precision. That’s why we encourage our broker and consultant partners to review financial year 2021 Uniform Data System (UDS) data. Alternatively, we can provide an actual claims analysis repricing upon request. But remember, network discounts are just one part of how you can save money.

Gaining control of your costs

When it’s time to look at your plan’s performance or consider a new benefits partner or provider network, you’ll want to consider discounts as a component of cost management. But there’s also so much more to offering a robust total cost of care savings solution. For instance:

    • Will the network have value-based contracting arrangements?
    • Will you have access to high-performance network options?
    • Will you have access to best-in-class cost containment and payment integrity strategies?
    • Will you have access to URAC-accredited medical management?
    • Will your health plan solutions impact unit costs?

Plus, it’s important to consider:

    • Predictive models for high-cost claimants.
    • Integrated care capabilities.
    • Access to broader site of care options.

Not all networks are created equal, but how you perceive discounts should be. That’s why when you’re looking at the big picture, how you perceive network discounts matters.

Contact your Meritain Health representative today for more information.