Network Strategies
Smarter Care.
Lower Costs.
Care Access & Healthcare Cost Containment Strategies
Most employers think their network is their health plan — but it’s really just one piece of the puzzle. Your care access strategy determines where employees go for care, how much you pay, and how much control you retain over the cost of healthcare delivery.
This page breaks down each stage of modern care access — from traditional PPO networks to direct contracting, direct primary care, and reference-based pricing — helping you understand your options and how to upgrade toward full transparency and control.
Stage 1
Traditional Networks (PPO, HMO, EPO)
This is where most employer health plans start. You lease a national carrier network like Blue Cross, Cigna, Aetna, or UnitedHealthcare, and your employees get “discounted” access to doctors and hospitals.
The problem?
Those “discounts” are taken off inflated chargemaster rates, with little visibility into what’s actually being paid or why. The carrier decides who’s in-network, sets pricing behind closed doors, and keeps the savings data locked away.
It’s simple and familiar — but it’s also the most expensive and least transparent model available.
Stage 2
High-Performing & Narrow Networks
High-performing networks focus on quality, outcomes, and efficiency instead of broad access.
They identify providers with better outcomes, lower readmission rates, and proven cost performance — saving employers 10–15% without cutting access.
Some examples include SmartCare, Centivo, or Edison Health, as well as custom regional networks built directly with health systems that reward quality and transparency.
This is a strong middle ground — smarter access without full disruption.
Stage 3
Direct Contracts & Direct Contract Aggregators
Direct contracting removes the carrier altogether. Employers negotiate directly with hospitals and provider groups to secure flat, transparent rates for procedures, surgeries, and specialty care.
Think of it as wholesale pricing for healthcare — fair, pre-negotiated rates that eliminate carrier markups.
Direct contract aggregators like Carrum Health, Coral.io, or Consociate make it simple by managing relationships and offering employers plug-and-play access to existing direct-to-employer (D2E) agreements.
No need to reinvent the wheel — just leverage proven contracts that already deliver results.
Typical savings: 15–30% vs. traditional PPOs.
Stage 4
Direct Primary Care & On-Site Nurse Visits
This is where care becomes personal and preventive. Instead of waiting for employees to get sick, DPC and on-site care models focus on keeping them healthy — and out of the high-cost system.
- Direct Primary Care (DPC): Employees get unlimited access to a primary care doctor, same-day appointments, no copays, and longer visits. These doctors handle 80–90% of healthcare needs and coordinate with specialists when necessary.
- On-Site or Near-Site Clinics / Nurse Visits: Perfect for manufacturers or logistics companies. These clinics offer acute care, labs, and wellness services on location — reducing absenteeism and driving engagement.
Employers adopting these models typically see 40% fewer ER visits and better overall employee satisfaction.
Stage 5
Reference-Based Pricing (RBP)
At this stage, employers set the price — not the carrier.
RBP uses publicly available Medicare benchmarks (typically 120–170% of Medicare) to establish fair, defensible payment rates for medical services.
No networks. No hidden discounts. Just transparent, benchmarked pricing.
When paired with patient advocacy, balance-bill protection, and direct contracts for high-cost services, RBP can reduce plan costs by 30–40% while giving employers total control.
BeneSmart helps employers in St. Louis, Kansas City, Springfield MO, Tampa, Orlando, Naples, Dallas, Houston, Austin, and Milwaukee improve employee healthcare access through transparent provider networks, direct contracting, direct primary care, reference-based pricing, and cost containment strategies. We work with CFOs, HR leaders, and business owners to reduce healthcare spend, improve care quality, eliminate hidden pricing, and create smarter health plan structures built for long-term financial sustainability.
Transition from
Access to Alignment
Understanding where and how your employees access care is step one. The next step is making sure every vendor — from TPA to PBM — shares the same incentives, goals, and accountability standards. Discover how to take control of healthcare access and costs.