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What are high-performance networks?

High-performance networks deliver superior care outcomes at a lower price point. Providers that deliver higher-value care (high quality at low cost) are placed the network.  Generally, HPN networks are accompanied by benefit incentives, designed to reduce the out-of-pocket cost to patients when they seek care from an HPN provider.

Do high-performance networks improve the quality & affordability of care?

High-performance networks are designed to reduce spending while continuing to provide patients with a high quality of care. 

In 2010, the Commonwealth of Massachusetts Group Insurance Commission (GIC) introduced high-performance network plans for its members. Researchers from the National Bureau of Economic Research found that GIC enrollees who switched to the new plans spent about 36% less, which reduced the GIC’s total spending by 4.2%. Further, the number of primary care visits increased, as did primary care spending (28% increase), but this was more than offset by fewer visits to and lower expenditures on specialists (45% reduction).1

In a more recent study, researchers examined data from a large payer in the southeastern U.S., which offered plans in the state marketplace. In 2014, the payer introduced high-performance network plans, alongside broad network plans. Results show that consumers enrolled in high-performance network products had lower mean outpatient out-of-pocket expenditures and 10% lower premiums than individuals in the broad network plan.2 

Another group of researchers focused specifically on the small group market—companies with approximately 2-50 employees. They concluded that 96% of the savings from the high-performance network was attributable to the selection of lower-cost providers in the high-performance network, who also may order fewer tests or refer less frequently to specialists or prescribe fewer drugs.3

1 Jonathan Gruber and Robin McKnight “Controlling Health Care Costs Through Limited Network Insurance Plans: Evidence from Massachusetts State Employees,”

National Bureau of Economic Research Working Paper 20462 (September 2014) http://www.nber.org/papers/w20462.pdf at 4, 21, 23-24.

2  Emily Gillen, et al. “The Effect of Narrow Network Plans on Out-of-Pocket Cost,” American Journal of Managed Care (September 19, 2017)

https://www.ajmc.com/journals/issue/2017/2017-vol23-n9/the-effect-of-narrow-network-plans-on-out-of-pocket-cost at 540-545, 542-543.

3 Alicia Atwood and Anthony Lo Sasso “The Effect of Narrow Provider Networks on Health Care Use,” Journal of Health Economics (2016) at 92-93.