What we know and do not know about tiered provider networks.
In response to continuing concerns about escalating health care costs and poor quality care, many health plans have adopted a strategy called "tiered provider networks." With TPNs, plans provide financial incentives for members to utilize hospitals, primary care physicians, and/or specialist physicians identified as performing especially well in terms of cost-efficient and/or high-quality care. The strategy is relatively new, and little is known about TPN structure, implementation, or operation. In this article, we present findings about tiered provider networks developed from a national survey of health plans and from interviews with health plan executives, their employer clients, and providers in their networks.
Thomas
J William
JW
Institute for Health Policy, Muskie School of Public Service, University of Southern Maine, USA.
Nalli
Gino A
GA
Coburn
Andrew F
AF
D003363:Cost Control; D003625:Data Collection; D004465:Economic Competition; D006264:Health Benefit Plans, Employee; D007348:Insurance, Health; D007407:Interviews as Topic; D012051:Reimbursement Mechanisms / Q000458:organization & administration* / Q000639:trends; D014481:United States