Quality Is Not A Constant In PPO Networks

There are quality providers and poor quality providers. Why would you choose the later?

By Jeff Bernhard via Linkedin
What is amazing to me in the Large Employer self-funded healthcare purchasing space is that an RFP will ask for things like a “network discount” but ask nothing around what the TPA/Carrier does to ensure that members only see the top 10% quality providers for every surgeon and speciality in every area of the Country.   
Quality of care delivered by each specialist and surgeon is not a constant.  As an example there are 160 orthopedic specialists that do spinal surgery in Houston, Texas, yet only 10 of them are rated at 90% or higher from the Gold standard Quantros Risk adjusted CMS data.   Yes, only 10, yet all 160 are in every large carrier network.  Many of them below 40 % quality/safety ratings. You would never know.
Why would you want to see any provider rated less than 90% from an objective, credible database to operate on you?  You wouldn’t.  This is your body and your health overall. 
Quality is not a constant in these networks, period.  Consumers deserve to know the highest quality ranked doctors, by specialty. 
We are doing better. This is TopCare. This is Continental.

Jeff Bernhard – President of Continental Benefits

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