1. Strategies for Dealing with Narrow Network Products
Richard Miller
HFMA Academic Medical Center CFO Council
Monday June 27, 2016

3. Narrow Networks: NY Hospital Participation in Health Exchange Plans
*Participation Status Based on Plan Provider Directory Search, June 2016

4. Navigating the Turbulent “Narrow Network” Seas
Source: Deloitte University Press, Deloitte Review Issue 15

5. Narrow Networks:
“To Par or Not to Par” – That is the Question!
Considerations:
Patient Access
Plan Membership
Price
Benefit Design
Utilization
Network Design

6. Provider Sponsored Health Plan: CareConnect
Part of the force driving our perspective on providing high quality, low cost health care stems from the creation of our health plan, CareConnect.
Benefits in Changing Market
Direct necessary services into narrow network of Northwell Health providers and partners
Provide new revenue/margin opportunity (“Piece of the Premium”)
Develop organizational capabilities and competencies in care coordination, utilization management, and value-based care
Provide an exceptional experience to our customers
9/19/2018

7. Measuring The Shift In Utilization – Initial Study
Analysis Results
Northwell performed analysis of shift in utilization patterns for CareConnect members with a utilization look-back vs. prior 3 years.
Results Indicated:
Unmatched

8. Lessons Learned
Exchange products in NY Market have “narrower" provider networks, which may impact both price and utilization.
Providers must weigh multiple considerations including Patient Access, Pricing, and Utilization impacts from participation in Narrow Networks.
Payers must consider geographic coverage, competitive pricing, and provider quality in order to build a “sellable” network for their products
Determination of Provider Participation status in narrow network products has been confusing and frustrating for patients.