Expanding and Evolving the Provider Network for Better Outcomes and Controlled Costs
A Network That Works Better for Everyone
A health plan is only as strong as its provider network. And ours couldn’t be stronger. Not just because of the number of hospitals and providers it includes in Rhode Island, New Hampshire, Massachusetts, and beyond. But also because of how we’re collaborating with providers and health care systems to make health care work better for our members.
1. Depth, breadth, and quality
Members want choice when it comes to their coverage. And in a region like New England, where living in one state and working or traveling to another is common, Tufts Health Plan believes members should have the freedom to get care where they want, from the providers they want.
- Our full provider network is 51,000 strong.
- Our network includes 100% of Rhode Island, New Hampshire, and Massachusetts hospitals1 including those in the Boston area, plus providers near the borders of surrounding states: 108 hospitals total.
- For national coverage, we work with the Cigna PPO Network, which includes more than 800,000 doctors and 6,000 hospitals nationwide.
2. Collaborating with providers for better care
Doctors love working with us—and the feeling is mutual. Strong provider relationships and more collaborative models of care are at the heart of our core business strategy. By sharing data, innovations, and incentives, we can control costs while providing our members with quality care. Our strong relationships and unique collaborations with providers are quite literally changing the way health care is delivered—to the benefit of our members.
Employers' interest in new care delivery models, including high quality and joint venture plans, has doubled over the past 6 years.2
Through our unique collaboration with Lifespan, Rhode Island’s first and largest health care system, we can:
- Share information with doctors and provide programs that support their treatment plans.
- Inject greater value into the system with contracting models that help ensure members pay for health care that works.
- Create new approaches to patient care, such as a referral process we created with a provider to help ensure consistent referral patterns for costly specialty care—an innovation that lowered claims costs by $1.6M.
- Reduce gaps and overlaps in care. Lifespan shares data with our nurse care managers, allowing us to provide proactive support for individuals who need it most and avoid duplication of services.
3. The power of tiered networks for cost savings
Through our relationship with Lifespan, members don't just benefit from quality care. They can also save money: Members pay lower out-of-pocket costs when they choose providers in the Lifespan provider network, through our Lifespan Premier Choice tiered plan options. Preferred providers, meanwhile, are incentivized to keep quality high and costs low.
When members access care from more than 1,800+ PCPs and specialists in the Lifespan system, they benefit from a lower share of out-of-pocket costs. Of course, they still have the option to see any doctor in the broad Tufts Health Plan network and pay a higher share of the cost. We also offer a special pairing option with our Advantage HMO plans, making it a strong choice for large-group employees who work in Rhode Island but live in Massachusetts.