Out-of-Network Matters

• 33% of revenue for hospitals and clinics goes out-of-network to competitors each year. This impacts health outcomes as the care plan may not be shared with out-of-network providers. In addition, it impacts revenue available to adequately serve a population.
• Programs such as Primary Care First (PCF) financially penalize providers with a leakage factor for out-migration or failure to align patients to their care team. For example, if 25% of visits are out-of-network then the PCF monthly population payment is reduced by 25%
• Now that all healthcare providers may request their Medicare data for patients, it is easy to track out-of-network and redirect patients to in-network and care-managed services.

Kris Gates | [email protected] | 402.321.6188