Looking to evaluate your high-performance network?

The Reform Evaluation Framework (REF) for high performance networks (HPNs) evaluates the impact of this type of network on costs, quality outcomes and utilization. For the purposes of this tool, we define an HPN as a narrow network comprising providers who meet pre-defined quality and cost requirements. Impact is measured in comparison to your members who are enrolled in your broader network (e.g. a PPO).

CONTENTS 

1. Definitions: Provides definitions of terms, cost and quality measures
2. HPN Report – Purchaser: Worksheet for evaluating HPN outcomes specifc to the purchaser’s member claims experience
3. HPN Report – Book of Business: Worksheet for evaluating HPN outcomes compared to health plan’s total book of business

By using this tool you will learn:

• The savings the HPN generates in primary care, specialty care, facility care and total cost of care compared to your broad provider network
• The cost trend for the HPN for primary care, specialty care, facility care and total cost of care compared to your broad provider network
• The difference in quality and utilization outcomes for the HPN compared to the broad provider network
• The out-of-network leakage for the HPN compared to the broad provider network