What’s Next: Exclusive Contracting Key to Solving Consumer Experience Puzzle


This is not your 2015 exclusive provider contracting. In 2016, these arrangements move beyond traditional narrow networks to deliver meaningful value-based components and differentiated consumer experiences.

Jim Fields

4 min read

Our “What’s Next” predictions series continues with this view from Jim Fields, Oliver Wyman’s Global Head of Health Services. He shares his perspective on the rise of exclusive network arrangements, explaining how in 2016 they move beyond traditional narrow networks to deliver meaningful value-based components and differentiated consumer experiences:

The use of narrow/exclusive networks is commonplace across the ACA/Individual and Medicare Advantage markets. However, until recently organizations haven’t captured the full value of these arrangements. First-generation narrow networks were simply super-charged ‘discounts-for-volume’ arrangements.

In 2016, we see these arrangements being extended into exclusive network arrangements that have two distinctive characteristics over traditional narrow networks: (1) meaningful value-based components and (2) differentiated consumer experiences for patients/members.   

With exclusive provider contracting, payers will be able to offer providers wrap-around support, such as communication and care management resources, that will help clinicians better manage patients’ care and lead to improved outcomes.

In the past, many plans viewed customer experience as a marketing effort; now plans are starting to recognize the business rationale behind enhanced customer experience and the direct link to Stars ratings. In 2016, more Medicare Advantage plans will pursue exclusive provider contracting in an effort to deliver a more navigable healthcare experience, drive higher quality, manage the cost of care, while boosting Star ratings and risk scores.

From the consumer perspective, an exclusive network can create a more streamlined and easier-to-navigate healthcare experience. Members benefit from new care management and wellness tools, as well as increased access to clinicians. For example, if a provider is exclusive to a particular Medicare Advantage plan, the consumer could have preferred appointment slots, and the ability to communicate with providers via email or telehealth.

If, as a member, it becomes easier to get an appointment with my doctor or communicate with my doctor’s office, and if I gain access to enhanced benefits or programs (such as health coaching), I will be more willing to engage with my provider. When the doctor’s office (or my health plan, through coordination with my doctor) contacts me about getting an annual check-up, it will feel less like an annoyance and more like a relationship.

From the plan perspective, granting consumers an improved experience will lead to more plan loyalty, greater member stickiness, and higher quality ratings. 2016 is the year of the next-generation exclusive provider network; one that focuses on consumer experience and value.