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Executive Brief

Medical network & provider economics

Measure network value before changing the network

A shareable guide for employers whose Health Plan Score identifies medical network economics as a priority—and the Roadmap action that turns discount assumptions into evidence-based purchasing.

By Corry Hull, REBC®, CSFS® — Vice President of Employee Benefits Consulting at BHC Insurance

A low score in medical network and provider economics is a signal to look beyond the network label and the headline discount. Employees experience healthcare through the prices, quality, access and sites of care that are available when they need services. A network decision should be evaluated through those realities, not an assumption that a larger discount automatically creates value.

Use the Roadmap’s Diagnose phase to identify material price variation. Review actual allowed amounts for commonly used services, the providers and settings associated with higher spend, employee access patterns and the quality information available for the decisions people are making. This turns a broad network conversation into a specific evidence review.

In the Design phase, define what high-value access should mean for your population. Consider primary care, specialist access, centers of excellence, referral support and site-of-care choices together. The objective is not simply to narrow or replace a network; it is to create a care path that helps employees reach appropriate, high-quality care at a reasonable price.

Then bring network performance into the leadership review cadence. Track the measures that matter, document the purchasing choices they support and require partners to explain progress. This makes a high-priority Score result a repeatable Roadmap discipline instead of a last-minute renewal debate.

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