June 01, 2023
As health care costs continue to rise, with some predicting significant increases in 2024/2025, large employers are continuing to consider and adopt high-performance network (HPN) designs that steer employees to higher-quality, cost-efficient providers while limiting or eliminating coverage for low-quality providers. When surveyed on plan design or eligibility changes for 2023, 16% of employer respondents plan to implement (or expand) HPNs.1
While care delivered by providers with a track record of higher quality is desirable, historically this approach has caused consternation among employees about the perceived “narrowing” of their network, especially if “my” doctor is somehow excluded or viewed as non-preferred. Effective communication can help employees take advantage of plan design incentives to use higher-quality providers while also allaying fears about having fewer providers in their network.
This article provides several tips to help employers address the challenges they face when communicating the value of HPNs, Centers of Excellence (COEs) and other network arrangements that limit coverage to higher-quality providers.
Insights from Employers and Communication Experts on Communicating About High-Value Networks
In the Spring of 2023, the Business Group’s Executive Committee on Value Purchasing held a roundtable focused on sharing employer experiences in communicating about HPNs, COEs, accountable care organizations (ACOs) and other value-based network arrangements to employees. Invited communication experts followed with insights on effective employee communications that describe the benefits of these options and the role of incentives in encouraging employees to take advantage of them.
A presentation from Gallagher (formerly known as ROC Group) showed how some communication challenges stem from a fear-based physiological response in the brain, specifically among emotion neurons in the amygdala that can lead individuals to misperceptions about the reasons why an employer might offer them an HPN, COE or other similar network design. “Our brains are wired to change facts to fit our fears,” Gallagher shared, “and to fit the truths we want to believe.” They emphasized the importance of addressing potential fears and skepticism directly. For example, in an effort to increase utilization of an HPN tied to lower premiums, an employer might say, “Yes, this network has much lower premiums. Why? Because you’re getting high-quality care from only providers who qualify.”
A communication expert from Brown & Brown further emphasized the importance of “reframing the story” about networks that only include a smaller number of higher-quality providers. They included action steps employers can take to do so (see Figure 1 below). Brown & Brown’s presentation noted that many of these techniques have already been used by employers to guide employees in benefit communications other than HPNs.
Figure 1: Reframing the ‘Story’
High-Performance Networks and Centers of Excellence
Emphasize Quality vs. Value
- Put a spotlight on the expertise and ratings of providers in the network (or COE)
- Highlight the determination of quality ratings
- Focus on getting more for their money with better outcomes
Highlight Equity vs. Restriction
- Lean into SDOH and tie into ongoing DEI initiatives
- Be honest about disparate access to care across the country
- Introduce the network or COE as an opportunity to bring greater equity into health care delivery
Reinforce Choice vs. Limitation
- Be clear about the no-cost, value-add service of COEs
- Leverage familiar messaging for in- vs. out-of-network coverage for other plan options (if applicable)
- Emphasize continued autonomy for provider choice (if applicable)
Source: Brown & Brown presentation. March 1, 2023. Executive Committee on Value Purchasing meeting.
5 Tips for Employers
- 1 | Focus on communicating improvements that will best resonate with your employee population: Highlight how HPNs/COEs/etc. provide superior health care delivery that result in a better patient experience, improved health outcomes and higher quality of care. Communicating generous plan design incentives to encourage people to select HPNs and other networks is useful, but without a discussion of why those incentives are in place, it can seem “too good to be true” and lead to assumptions that care will be worse.
- 2 | Proactively address potential concerns and communicate frequently about the benefits: Address any concerns employees may have about the HPNs/COEs, such as limited provider choice, by explaining the benefits of these arrangements and how they can lead to better care and lower costs. Include messaging about how the size of the network won’t limit time to care.
- 3 | Provide clear and concise information about where to get support: Make sure information and resources about HPNs/COEs/ACOs/etc. are easy to understand and are made readily available to employees on several modalities throughout the year. Include any restrictions or limitations on coverage. Moreover, ensure that employees are aware of how they can access any resources provided (e.g., online directories, referral programs, recorded sessions).
- 4 | Leverage evidence and data to help build your case: Be transparent about how providers are selected for effective HPNs/COEs or other “narrow” arrangements, such as lower complication rates, shorter hospital stays and lower readmission rates. This can help address assumptions that “narrow” networks are just a tactic used by employers to cut costs.
- 5 | Coordinate with vendor partners to communicate benefits: Work with your communication, navigation, health plan, provider and other partners to communicate the benefits of these network arrangements, as well as provide support to help employees manage their health care journey within that network.
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- 1 | Business Group on Health. 2023 Large Employers’ Health Care Strategy and Plan Design Survey. August 2022. https://www.businessgrouphealth.org/resources/2023-large-employers-health-care-strategy-survey-intro. Accessed May 30, 2023