Choosing the Right Health Plan: A Smarter Strategy for Your Bottom Line
Blue Daily
| 4 min read
Employer-sponsored health benefits continue to face pressure from rising healthcare costs and increasing premiums, requiring employers to balance affordability with the need to offer competitive benefits. As organizations evaluate their options, network strategy can play a vital role in managing costs while maintaining access, quality and positive employee experiences.
Moving from a traditional preferred provider organization (PPO) network to a more managed network doesn’t necessarily mean sacrificing access or quality. Today’s network and plan designs can provide employers with additional, meaningful opportunities to manage costs while connecting employees to high-quality care.
Why re-assessing your network strategy deserves a closer look
"The future of employer-sponsored healthcare isn't about choosing between affordability and access. It's about identifying solutions that deliver both. Employers who regularly evaluate their network strategy can uncover opportunities to manage costs more effectively while continuing to provide employees with access to the care they need,” says Yaniv Ribon, senior director of Commercial Products at Blue Cross Blue Shield of Michigan and Blue Care Network.
Because health benefits are a strategic workforce issue, employers are compelled to revisit plan design at each renewal. A periodic “network health check” uncovers opportunities to align the plan with actual utilization patterns, employee geography and corporate affordability goals.
Breaking common myths about HMO networks
| Myth: Managed care means less flexibility. | Reality: Modern point-of-service and HMO plan designs provide broad specialist and hospital access while steering utilization toward cost effective services. |
| Myth: Quality will decline. | Reality: Managed care models emphasize quality and value, using high performing provider networks and coordinated care pathways that improve outcomes. |
| Myth: Employees will lose access to their doctors. | Reality: Today’s POS and HMO network plan designs provide wide specialist and hospital access while steering employees toward cost-effective services. |
Looking beyond network size — a value‑based perspective
The largest network isn’t synonymous with the best value. Employers should evaluate:
- Quality of care, which is gauged by provider performance metrics, such as readmission rates and patient‑safety scores.
- Cost efficiency results through utilization of high‑value services and avoidance of unnecessary procedures.
- Coordinated care via integrated care management that reduces duplication and improves outcomes.
- Member experience feedback about the ease of finding in‑network providers, streamlined referrals and digital tools.
For example, BCN offers a custom primary care provider HMO network, PCP Focus, available in 31 Michigan counties. When an employer pairs PCP Focus with a BCN HMOSM medical plan (not including POS plans), employees have access to 3,600+ primary care physicians and 37,000+ specialists across a broad referral network, maintaining continuity of care.
Five questions every employer should ask before renewing their health plan
- Are we paying for network access our employees actually use?
- What factors are driving our premium increases and how much can network strategy influence them?
- Could a different network design improve affordability without creating significant employee disruption?
- Have we evaluated provider disruption using actual employee utilization rather than assumptions?
- Are there alternative plan designs that better balance affordability, quality and employee experience?
Consider current utilization patterns by identifying the top-used specialties and facilities and match them to in-network options. Look at your employee geography, rural versus urban distribution influences provider availability. What are your affordability goals? Targeting premium reductions of 10% can translate to $200,000 to $1 million in annual savings for mid‑size employers. Watch for renewal-increase trends by comparing year-over-year premium growth across your PPO, POS and HMO options.
How moving to a more affordable network strategy can create premium savings
The financial effect of a network strategy will vary based on an employer’s current plan design, workforce needs and utilization patterns. For employers looking to balance affordability with access and quality, Blue Cross offers a range of plan and network options designed to provide various levels of cost savings while supporting employee’s care needs. Options include:
Simply BlueSM PPO
Gives employers a 2% to 15% lower premium versus a traditional PPO. For example, a $2 million spend may result in $40,000 to $300,000 in savings.*
Blue Elect PlusSM POS
Gives employers up to an 11% lower premium versus a traditional PPO. For example, a $5 million spend may result in $550,000 in savings.*
BCN HMOSM with PCP Focus
Gives employers up to a 10% lower premium versus the standalone BCN HMO plan. For example, a $10 million spend may result in $1 million in savings.*
Does your current health plan still fit your workforce?
Choosing the right network strategy starts with understanding how employees use care, where they access it and what matters most to your business. By evaluating these patterns and your goals together, employers can make more informed decisions about the plan design that best supports both their people and business.
Learn how Blue Cross and BCN can help you balance affordability, access and quality with data‑driven plan options tailored to your needs today. Visit bcbsm.com/employers to explore available medical plan options and employer resources.
*Example assumes a 10% average reduction, and actual savings depend on plan design and utilization.
Photo credit: Getty Images
