PPO Networks

One of the most daunting challenges facing businesses today is providing health benefit plans with features that are attractive to employees and costs that are within corporate budgetary constraints. A well-built PPO network is a key component of such a plan.

What constitutes a well-built PPO network? A blend of inter-related factors: network penetration, convenience and discounts.

PPO network penetration.
This is a measure of the extent to which a company's employees utilize PPO network physicians and other in-network health care providers. The higher the utilization, the deeper the penetration. And the deeper the penetration, the greater the cost savings for employers who will have a greater number of in-network claims.

IMA PPO Network Links

PPO network convenience.
A key driver of PPO network penetration is convenience, that is, how easy it is for employees to use PPO network providers. Convenience depends on the geographic proximity of PPO network providers to employees' homes and workplaces, the ease of transportation to the provider's location, and the ease of billing and reimbursement matters from the employee's perspective.

Convenience also relates to the ease of identifying PPO network providers. PPO health network provider listings generally are available both in hard copy and online. Online listings tend to be more up-to-date and probably are the easiest way for employees to identify in-network providers. Online listings also provide maps and directions to providers' offices and enable employees to select providers based on area of specialization, gender, language and other relevant factors.

PPO network discounts.
The discounts associated with PPO network health services can vary substantially, depending on the network, the type of service and the geographic location of the provider. An experienced benefits administrator should be able to find the best PPO network for an employer based on their needs and the needs of their employees.

Deep network provider penetration and negotiated pricing discounts equal employer cost-savings.

The Purpose
To maximize PPO penetration and achieve deep pricing discounts for employers by making it simple, convenient and cost effective for plan participants to use in-network providers.

The Process
IMA facilitates optimal PPO penetration and deep pricing discounts through its extensive Provider Network. Primary and secondary network matches are based on workforce size, location and other relevant factors. IMA negotiates pricing discounts with out-of-area network providers when possible. Multi-location clients are connected with multiple networks, and network matches are routinely reviewed. Plan participants choose from an extensive list of in-network health care providers and facilities located in both urban and remote locations.

IMA provides educational resources and learning tools to familiarize participants with Preferred Provider Organizations and how they can save money by using in-network providers.

Primary Features
• More than 85 PPOs available to clients.
• Primary & secondary client-network matching.
• In-network providers located in remote areas.
• Deep pricing discounts with in-network providers.
• Fee negotiation with out-of-area network providers.
• Online provider search capabilities.

Key Benefits
Clients achieve significant cost savings through primary and secondary in-network pricing discounts and fee negotiations with out-of-area network providers. Plan participants have convenient, broad access to excellent medical care no matter where they are located. They understand PPOs and how to reduce their medical costs by using in-network providers.

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