What We Know and Do Not Know About Tiered Provider Networks

Journal of Health Care Finance
Vol. 33, No. 4
Summer 2007
Thomas, J.W., Nalli, G.A., and A.F. Coburn
pp. 53-67

In response to continuing concerns about escalating health care costs and poor quality care, many health plans have adopted a strategy called "tiered provider networks." With TPNs, plans provide financial incentives for members to utilize hospitals, primary care physicians, and/or specialist physicians identified as performing especially well in terms of cost-efficient and/or high-quality care.  The strategy is relatively new, and little is known about TPN structure, implementation, or operation.  In this article, we present findings about tiered provider networks developed from a national survey of health plans and from interviews with health plan executives, their employer clients, and providers in their networks. 

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