The Case for Narrow Networks
Narrow networks restrict coverage to a smaller set of providers — typically those who have agreed to lower negotiated rates and who meet quality standards. Well-designed narrow networks can reduce plan cost by 15–25% compared to broad PPO networks, while maintaining or improving quality of care.
Provider Selection Criteria
- Quality metrics: HEDIS scores, patient satisfaction, readmission rates, complication rates
- Cost data: Negotiated rates relative to market; total cost of care for common procedures
- Member utilization: Which providers are most used by your employees?
- Geographic access: Are there sufficient in-network providers within a reasonable distance of employees?
- Specialty coverage: Are all necessary specialties represented in the network?
- Hospital affiliation: Do the in-network physicians have admitting privileges at in-network hospitals?
Employee Communication
Watch Out
Narrow network failures are almost always communication failures. Employees who discover their preferred provider is out of network when they need care — not during open enrollment — are angry and distrustful. Proactive communication before the plan year starts, including a provider lookup tool and a process for requesting network exceptions, is essential for narrow network success.