December 2015, Issue 11:
The Future of PPOs & Provider Contracting
This publication is designed to provide useful, timely and actionable information on a host of topics impacting the health insurance and healthcare markets.  Each quarter we identify a "hot topic" in
the market and solicit articles from industry leaders to provide varying perspectives on issues and opportunities.

If you are a Self-Insured Employer, Payer, Labor or Trust Organization, Stop-Loss Carrier, Health
Plan or a business that services this market, this publication can be a useful source of information
and guidance.  We hope you find this valuable and encourage your feedback, including future topics on which you would like more information. 
Provider Contracting Options in an Evolving Healthcare Market
      Every day we receive email blasts and newsletters with headlines
      discussing revenue based contracting, High Value and Narrow
      Networks and the future of PPOs. There are those that suggest
      that the PPO is a dying entity, to be replaced with a referenced
      based solution for paying Providers, while others see the value in
      a PPO network offering, but struggle with how to improve the
      impact on the Health Plan's medical spend.  
            Design and Contracting Considerations for Plans and
Networks for a Value Driven Healthcare Industry
      Historically the healthcare industry has moved cyclically through
      periods of significant change in response to various drivers
      followed by periods of relative calm and consolidation - only to
      begin the cycle anew when conditions change again. Driven by
      steady cost increases combined with various aspects of public
      policy, the healthcare industry is once again in a state of
      increasing instability. 
Narrow Networks & Reference-Based Pricing Gain Interest 
by Emphasizing Quality Care at a Cost-Effective Price 
In the current healthcare environment, Insurers & Employers continue to look for ways to control
premium increases and lower healthcare costs.
Network construction is at the center of cost containment and care quality discussions. Emphasis 
is being placed on steering employees toward the best performing and most cost-effective Providers.
Employer Direct Contracting:
Significant Benefits for Employers, Providers & Patients 
Healthcare reform is kicking into high gear, impacting  
Employers, Providers and Patients across the United
States. Many large Employers face substantial
monetary penalties for non-compliance with the new
regulations, even as the cost of providing health
benefits continues to rise. In response, business
leaders are adopting new strategies to combat the 
impact on the bottom line and ensure quality outcomes.  
Direct Contracting: How Employers Can
Reduce Their Healthcare Spend 
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      As healthcare costs continue to rise and the new
      Health Law (ACA) accelerates this trend, Employers,
      as the Payers for healthcare, are seeking strategies
      to contain their healthcare costs. A PPO can offer
      broad access; however, it is like a third rail for
      Employers for containing their healthcare costs.  
UCS Update: High Value Narrow PPOs
Introducing the NX Health Network
   
    NX Health Network is a NEW! High Value PPO Network giving Payers and Employers 
    a cutting edge alternative to standard "any willing Provider" networks that offer limited
    ability to manage Provider and Plan Costs. NX Health Network is creating Client Specific
    networks nationwide that directs Patients to choose from a select list of Providers, while
    also offering quality and cost-effective services. NX Health Network offers the best of two
    worlds; dramatic savings through Medicare Plus payments to Providers, combined with
    the peace of mind of a contracted PPO Network. 
To submit an article or learn how you can access UCS's industry
leading services:

Corte B. Iarossi, VP of Sales & Marketing
(866) 762-4455 x120
ciarossi@unitedclaim.com