What We Know and Do Not Know About Tiered Provider Networks
Cutler, Population Health and Health Policy
Journal of Health Care Finance
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.
Thomas, J. W., Nalli, G. A., & Coburn, A. F. (2007). What we know and do not know about tiered provider networks. Journal of Health Care Finance, 33(4), 56-67.