Network Savings Programs

We leverage strong, collaborative relationships with more than 51,000 doctors and every hospital in our service area, giving our members broad access to affordable, quality care.

Our Approach to Provider Contracting

As part of our contractual arrangement, we pay care management fees to help network providers achieve our mutual goal of improved health outcomes. The fees support providers’ efforts to eliminate gaps in care, reduce readmissions, and enhance the quality of care.

Outside the service area, we have negotiated with national, third-party administrators to provide access to care at discounted rates. This flexible approach to network design achieves significant savings on out-of-area care while assuring access to quality providers for our members, regardless of where they live.

We leverage our highly collaborative provider partnerships to structure innovative and flexible arrangements that promote the delivery of high-value care for our members and purchasers of health care coverage:

• A robust network of Commercial providers, ensuring adequate coverage and a wide selection of care options for our clients and insured members
• An innovative approach to the deployment of Centers of Excellence (COEs) for specified service lines, promoting high quality, efficient providers willing to accept financial accountability for the cost of care delivered
• The development and promotion of our High-Perfomance Networks (HPNs) is intrinsically tied to the creation of high-value narrow and tiered networks

Value-Based Arrangements

We structure value-based arrangements that remove the incentive for increased usage, and offer financial incentives to providers to maximize population health and wellness and focus on cost efficiency. These arrangements are predicated on providers accepting accountability for the cost and quality of care delivered.

Patient Centered Medical Homes (PCMHs)

We are fully engaged in supporting PCMHs, which materializes in clinical, financial, and technical resources.

Out-of-Network Claims Pricing

Using claim edits and clinical expertise, this program favorably reprices care received out-of-network, within our service area. The program also negotiates discounts in the rare instance where a provider is not contracted with us.

Out-of-Area Network Savings

Through this program, Massachusetts- and Rhode Island-based employers have access to enhanced discounts at over 800,000 doctors and 6,000 hospitals nationwide through our strategic relationship with Cigna. This provides greater access to network-based care and better claims pricing outside the Tufts Health Plan service area.

National Transplant Network

Offers access to a national transplant network at discounted rates. The network uses a rigorous evaluation process and connects our members to clinically superior, cost-effective care.