BUILDING BLOCKS > MANAGER > Benefit Administration & Organization

Provider Networks

How are networks organized to ensure consumers have access to high-quality, effective, and low-cost care?

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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 care and specialty physicians, as well as all health care services included under the terms of the contract. source

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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.

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