With the current batch of limited network products in the market today, many payors have achieved short-term victories in the cost-containment game. However, there are significant shortcomings with many of the narrow network products currently in the market that, if not resolved, will limit their impact to drive value in the market over the long-term. Challenges remain for consumer decision-making both at the time of purchase and at the point of care, including understanding which providers are in or out of network. Additionally, current determinations of network inclusion/exclusion are highly reliant on unit price rather than drivers of long-term total cost and value such as utilization and quality measures.
In this paper, we share two significant focal points for payors to address these shortcomings, evolving the design and accessibility of narrow and tiered network products in support of longer-term sustainability. We also describe the opportunities for payors to reinforce the repositioning of network design as a key strategic differentiator, including realignment internally—in how payors are organized—as well as externally—in how payors relate to providers.