Insurer/Payer FAQ

Community-based practices increase access to care, giving patients more network options. Often, practices outside the hospital systems are more efficient, providing our insurer’s members shorter wait times and more focus on customer service. Practices outside the hospital systems have more transparent and less complex billing. For example, these practices generally do not charge facility fees, which clearly influences member satisfaction. The PA Clinical Network is also an intermediary that understands insurer and physician needs and reconciles both perspectives. Physicians within the PA Clinical Network view insurer relationships as more collaborative.

Community-based physicians and practices account for 1/3 of insurer’s care, representing a significant portion of an insurer’s overall network. Community-based physicians take the time to provide quality care. This provides them the opportunity to connect with their patients and build trust – that trust is then passed on to the insurers with which the physicians collaborate through their relationship with the PA Clinical Network .

Aggregating membership allows the PA Clinical Network practices to mitigate some of the insurer’s risk and spread out any catastrophic cases across a much larger membership base. This increases potential upside from quality and patient satisfaction, and lessens potential downside financial impact from these types of arrangements.

PA Clinical Network member physicians widen their referral networks, allowing them to engage with new or different specialists and hospital systems that they may not otherwise have access to or know about. Members are encouraged to collaborate with each other via PA Clinical Network resources and events. This collaboration results in stronger care communities for our insurer’s members, breaking down communication barriers between treating physicians across a patient’s continuum of care.

Our organization is focused on enhancing relationships between practices and payers. The PA Clinical Network is committed to bringing insurers and physicians together on neutral ground to maximize quality measures using a common, effective set of measures. The PA Clinical Network continues to expand its footprint, offering its network to additional Pennsylvania insurers and – most importantly – building on the success of the current network by joining with additional independent physicians who are committed to succeeding in value-based care for their patients.