How High Performance Networks Will Change Healthcare

Published December 14, 2020

Author: Kari Hedges

Kari Hedges

Raise your hand if this sounds familiar: you go to the doctor for a minor concern. The nurse runs through a series of questions and checks your vitals before the doctor comes in. He or she spends 10 minutes with you, addresses your ailment and writes you a prescription. You're free to go.

It all feels a bit transactional.

I think most of us can agree that a better care experience is one in which we feel like our doctor knows us. One that gets us healthy and keeps us healthy, where care is coordinated among our healthcare providers. To be clear, this is what doctors want too. They went into medicine to help people.

The truth is that payers, providers and patients all want the same thing: better health, improved access and greater affordability. It's our responsibility as an entire healthcare industry to think about the patient first and make their experience better.

So how do we get there?

Here, four guiding principles to help align the healthcare system as we move forward:

  1. Create stronger partnerships - In order to make any meaningful change in this industry, payers and providers need to team up. If we're both tackling the same goals, let's sit at the table together and come up with solutions that are twice as effective in half the time. Yes, this will require change readiness and additional tolerance for risk. That's on top of the time and resources it takes to effect system-wide change. That's why partnerships like creative payment models, distinctive networks and other innovative collaborations are so important—so we can share these risks and resources.
  2. Shift incentives - It's simple: commit to value. If we preach high-quality, affordable care, we need to incentivize that type of care. In practice, this looks like risk-based contracting, or value-based care arrangements. Though sometimes difficult to shift from a fee-for-service to a fee-for-value model, it’s the partnership mentioned above and openness to change that helps make it happen. We collaborate to help provide the time, data and resources needed to bring this win-win-win solution for the payers, providers and patients.
  3. Expand care options – One thing 2020 made very clear is that that the mode and site of care delivery are shifting, whether or not we’re ready for it. Telehealth, at-home care, remote monitoring are all here to stay. To be sure, these capabilities existed before COVID-19, but the pandemic increased our exposure to them and catalyzed our readiness for them. Not only are many patients ready to adopt this change, but so are doctors and insurers. High performance networks which incentivize cost and quality are a natural vehicle to facilitate this necessary expansion in a scalable way.
  4. Own our accountability - The healthcare industry impacts every single person in the nation. That's the scale we're talking about. So change isn't going to come quickly and it won't come easily, either. That doesn't mean it's not worth it, it just means we all need the fortitude to commit to long-term change. And we all need to own that responsibility together--simply because it's the right thing to do.

Blue High Performance Network

One of the ways Blue Cross and Blue Shield companies are working toward these goals is our new Blue High Performance Network (Blue HPN), available to members in January 2021. This new, narrow network will provide access to a national footprint of the best physicians and facilities in a patient’s hometown and across the country. When it goes live, it will be available to 185 million Americans in over 55 major markets nationwide—the only high performance network available in all top 10 U.S. cities.

This launch builds on our patient-focused, value-based care payment programs to focus on preventive, coordinated care that helps people get healthy faster and stay healthy longer. We are so excited to share this product with our members across the country, arming them with the confidence that they are receiving the best, most affordable care.

One customer we spoke with recently—a manufacturing company with employees across the county—expressed real excitement to share Blue HPN with its lower-income employee population. Making this product available means their employees will have access to rich benefits at some of the most affordable rates they can offer. That’s a huge step in the right direction.

Keep moving the needle

On a scale of where we started to where we need to go, we're still immature as an industry. But the needle is moving. Not only is our Blue HPN network expanding national access to higher-quality, value-based care, but the coronavirus pandemic has forced us to collaborate to a degree we’ve never before seen.

To everyone working toward these big goals of quality and affordability: Don’t give up. Let’s work together and share ideas along the way. My hope is that as these models continue to deliver on better outcomes and lower cost, the common goals we all share will become central to our industry and all Americans will get access to the care they deserve.


About the BlueCross BlueShield Association

The Blue Cross and Blue Shield Association is a national federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans.