Network Adequacy

Policy Definition: Network adequacy refers to a health plan's ability to deliver the benefits promised by providing reasonable access to a sufficient number of in-network primary and specialty care clinicians, as well as all health care services included under the terms of the contract. source

Network Efficiency

Policy Definition: Network efficiency refers to provider networks that are limited to providers who consistently provide higher quality and lower costs. These networks typically contain a small amount of providers and are continuously monitored on performance metrics.