Not All Networks Are Equal

Not All Networks Are Equal
March 2, 2023 Sue Riordan
Not all networks are equal

What are the hallmarks of a good provider network? If you said, “access to the right health care professionals” and “savings”—you’re on the right track. No doubt, these are two important factors. But, more goes into building a quality network than simply access or discounted costs. It’s important to recognize not all networks are equal.

At Meritain Health®, we connect you to an array of network products—making sure you have the right access to care with strong discounts and so much more.

Carefully chosen providers

A good network is first built from strong relationships with doctors, hospitals, health care providers and facilities. Our network teams work hard to form these connections, strategically accepting providers.

To do this, extra time and consideration goes into our credentialing and selection process. Careful credentialing ensures you’re getting care from quality providers every time. And strategic selection makes sure we’re choosing the right providers at the right cost.

So, you’ll have a network you can be confident in. To make it a cut above the rest, members always have access to quality care at their fingertips—how and where they need it.

Convenient access to the right providers

For example, with our broad network option from Aetna®, you’ll have convenient access to over 1.6 million health care professionals, which includes:

    • Over 776,000 doctors.
    • More than 6,100 hospitals.
    • Over 307,000 behavioral health specialists
    • Convenient MinuteClinic® and HealthHUB® walk-in locations, open seven days a week.
    • Virtual primary care options.
    • Centers of Excellence.

In addition, high-performing network solutions can help you with more strategic network designs.

These help you optimize savings by steering members to the best health care options in your area. Oftentimes, they’re also integrated with population health management solutions, allowing for a coordinated care experience. In this type of solution, accountability measures are put in place to ensure providers are engaged in a member’s health care journey. This can enhance your savings and healthy outcomes.

More than simply discounts and access

A sophisticated network—like the ones we offer—go beyond just rate discounts. You also need safeguards in place to protect your savings.

Building these protections into our agreements is a big priority. We do this as often as we can, so you’ll get multiple surgery reductions, reassurance claims are submitted on time, language that protects against paying more than what was billed and much more.

Networks are also integrated with cost-containing solutions that’ll save you even more. These protect your claims from things like fraud, waste and abuse and high-cost claims. For example, a high-cost negotiation team works to further reduce your claims with high price tags.

Centers of Excellence

When surgery or specialized care is needed, Aetna Institutes™ makes it simpler to choose a quality facility. This unique program offers you access to a network of high-performing—and cost-effective—

hospitals, clinics and health care facilities. It’s something we’re proud to connect you to—and something you’ll only find in the Aetna® network.

These specialized care facilities include:

    • Institutes of Quality® (IOQ)—specialty facilities for bariatric, cardiac and orthopedic procedures. Based first and foremost on care quality, IOQs must meet rigorous industry-based standards.
    • Institutes of Excellence™—offering care and surgeries including transplants, infertility, pediatric and congenital heart surgeries. Facilities must meet quality criteria such as success rates, number of procedures, cost-effectiveness, patient return rate and more.
Choosing your network

Once you realize what sets a network apart—you may be ready to pick the option that works best for you. When you’re ready to choose, we have the right network solution, design and strategy to match your goals.

Whether you’re looking for a broad network solution—such as the Aetna Choice® POS II network—a high-performing network or a custom network solution, we’ll help you find one that’s right for you.

Contact us today to learn more about your full range of options—and why not all networks are equal!

This article is for informational purposes only and is not meant as medical advice.