Your provider network matters. From access to top doctors to coverage across regions, the network you choose can impact employee satisfaction and your bottom line. Before selecting a health plan, use these tips to evaluate the quality, reach, and value of each network — so your employees can get the care they need, when and where they need it.
What to Look for in a Health Care Provider Network
1: Assess the health care provider network.
Ask your broker about the providers associated with each of the health plans you’re considering. How many doctors, hospitals, and specialists are available? Which ones are part of the HMO network? Which ones are PPO only? Who is in-network? The larger the network, the greater access your employees have to a more diverse roster of health care professionals — statewide and nationally.
2: Check the quality and reputation of potential providers.
Choosing the right health plan and provider network isn’t just about the number of providers available. It’s also important to look at the quality of the doctors, specialists, and hospitals. Health care quality is measured using metrics like patient outcomes, safety, efficiency, patient-centered care, equity, and patient satisfaction. Providers with high ratings for excellence are more likely to be appreciated by your employees.
Types of Ratings:
Patient Outcome: Measures include mortality rates, hospital readmissions, infection rates, and patient recovery rates.
Safety: Focuses on preventable harm and patient safety indicators.
Efficiency: Evaluates resource use and the cost-effectiveness of treatments.
Patient Satisfaction: Based on feedback about interactions with providers, facilities, and overall satisfaction.
Structural Measures: Includes staff capacity to provide care, commitment to improvement, and use of electronic health records.
Process Measures: Assesses whether providers follow care protocols and how quickly patients receive necessary services.
Patient-Centered Care: Examines patient involvement in decision-making and their overall experience with care.
Helpful websites for measuring health care quality are the Centers for Medicare & Medicaid Services (Medicare.gov), the National Alliance for Care at Home (CaringInfo.org), Hospital Compare, the National Committee for Quality Assurance (NCQA), the Robert Wood Johnson Foundation (RWJF), Healthgrades, RateMDs.com, and Vitals.com, among others.
3: Think about how accessible the location is.
If your workforce is spread out geographically, consider where your employees are located. Are they spread across a metro area or in different regions? A network with plenty of providers in one area but few in another — or in a more distant city — might not be the best fit for your team. Ensure there are in-network providers conveniently located near your workplace or your employees’ homes.
4: Be aware of out-of-network coverage and limitations.
Make sure to check each plan’s rules about out-of-network care. Will you and your employees be partially covered if you go out of network, or is staying in-network required for all services? What kind of emergency care will be available? If your employees travel for work, it’s important to know what kind of care they can access while away from home.
5: Do the plans you’re considering offer any extra benefits?
Some health plans include extra benefits at no additional cost to employers or employees. CaliforniaChoice, for example, provides added value through its Business Solutions Suite and Member Value Suite.
The Business Solutions Suite offers:
- Flexible Spending Accounts (FSAs) for employees
- Cal-COBRA or federal COBRA billing for COBRA participants
- Premium Only Plans (POPs) that let employees pay their premium share with pre-tax dollars
The Member Value Suite includes:
- Reduced-fee dental care through Dentegra Smile Club dentists
- Discounts on vision care, including frames, lenses, and exams
- Savings on hearing care and prescription drugs
- Discounts on wellness programs, gym memberships, movies, theme parks, travel, and more
Choosing What’s Right for Your Business
Choosing the right provider network is just as important as selecting the right health plan. When your employees have access to trusted doctors, convenient care, and meaningful extras, they’re more likely to stay engaged, productive, and loyal.
That’s where CaliforniaChoice stands out — offering flexibility, access to multiple health plans, and built-in value-added benefits. It’s a benefits solution designed with your business in mind.
Ready to explore your options? Ask your broker for a CaliforniaChoice quote. If you don’t already have a broker, we make it easy for you to find one online.
