What to measure
Evidence before assumptions.
- Allowed amounts
- Price variation
- Quality indicators
- Access to high-value providers
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Component 03
Medical Network & Provider Economics
Are we paying reasonable prices for high-quality healthcare?
Clear definition
Medical network and provider economics is the ongoing work of evaluating actual allowed prices, quality, access and care settings rather than equating a network discount with value.
Common mistakes
What weakens performance.
- Assuming a large PPO discount means a low price
- Treating network access as the only purchasing criterion
- Ignoring site-of-care differences
High-performance practices
Build a deliberate approach.
01
Benchmark actual allowed prices
02
Evaluate provider quality and patient access alongside price
03
Consider direct contracting, reference-based pricing and centers of excellence where appropriate
Book connection
Chapters 3–5: What healthcare really costs
Chapters 3–5 and 21
These chapters distinguish a discount from a price and connect provider economics to actual employee access.
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Medical Network & Provider Economics
Are prices, quality and site-of-care choices evaluated together when employees seek care?
A lower score suggests beginning with price variation and access evidence before changing network strategy.
Take the Health Plan ScoreEmployer Benefits IQ resource
Medical Network Strategy Guide
A printable Employer Benefits IQ worksheet for defining the decision, evidence, accountable owner and review cadence.
Author perspective
By Corry Hull, REBC, CSFS — Author, The High Performance Health Plan and Founder, Employer Benefits IQ.
Explore the Health Plan Score