How to Evaluate Healthcare Network Solutions for Self-Funded Employers

For self-funded employers, and the TPAs and regional carriers that support them, healthcare network solutions play a critical role in balancing cost control with quality care. These solutions determine how members access providers, how much they pay and how well their needs are met across diverse geographies and care settings.

Today’s workforces are more complex than ever, often spread across multiple regions, made up of variable-hour workers or facing unique coverage challenges. At the same time, healthcare costs continue to rise, putting pressure on employers to find smarter, more flexible options.

Leased or Rental Networks

This is a traditional and widely used option. In this model, plans partner with an established network provider that already offers extensive geographic coverage. This approach provides a quick and convenient path to network access. However, because the network is pre-established, there may be less customization available, and visibility into provider performance and rate negotiations can vary depending on the agreement.

Direct Contracting Networks

With this model, the plan or TPA contracts directly with providers and health systems. It gives greater control over pricing, quality, and access, and can lead to significant savings. However, it requires more administrative coordination, especially for credentialing, contracting, and managing provider relationships.

In this article, we’ll explore how to evaluate healthcare network partners, what to look for in terms of access and performance, and how the right solution can support both your business and your employees.

Understanding Your Options: Types of Healthcare Network Solutions

When evaluating healthcare network solutions, it’s important to understand the different models available and how they align with your plan’s goals. Each approach offers trade-offs in terms of cost, control, and administrative complexity.

Custom Tiered or Wrap Networks

These solutions offer a hybrid approach—allowing plans to build a custom network based on specific performance, cost, or access criteria, while still leveraging broader network reach when needed. Tiered networks can steer members toward preferred providers without eliminating choice, and wrap networks can fill in coverage gaps in hard-to-reach areas.

At MagnaCare, our extensive and high-quality provider network enables us to offer multiple network configurations tailored to the needs of labor groups, self-funded employers and unique member populations.

Key Factors to Evaluate in a Network Solution

Choosing the right healthcare network solution goes beyond counting providers. It’s about finding the right fit—one that aligns with your population, cost objectives, and operational needs. Here are the most important factors to consider when evaluating network options:

Network Adequacy and Access

A strong network starts with meeting members where they are. Does the network offer sufficient coverage in the right geographic regions? Are there enough primary care physicians, specialists, and facilities to support your population’s needs?

It’s also important to ask how providers are credentialed, audited, and held to quality standards. A large network isn’t helpful if it lacks high-performing or accessible providers.

Flexibility and Customization

Not all member populations are the same—and your network solution should reflect that. Beyond offering different network types, your partner should work with you to design a model that aligns with your plan’s priorities.

Look for the ability to:

• Prioritize high-performing providers through preferred or tiered access
• Adapt the network over time based on utilization trends and member feedback
• Integrate with third-party vendors for specialty services without disrupting the overall experience

Customization isn’t just about access, it’s about designing a network strategy that evolves with your population and your goals.

Claims Integration and Cost Transparency

How the network ties into your claims process is just as important as who’s in it. Here are a few things to ask for:

• Real-time claims integration that supports faster processing and fewer errors
• Tools that give you clear visibility into cost trends, utilization and provider billing
• Whether the network enables smarter contracting strategies through actionable data

Integrated claims and network data are essential for controlling spend and making informed benefit decisions.

Provider Relations and Service Standards

Behind every network is a provider experience that impacts your members directly. Are participating providers actively supported and engaged? Is there a clear process for handling escalations, credentialing and renewals?

Strong provider relationships often lead to better member experiences, fewer disruptions and improved outcomes. Look for network partners who not only build access but also invest in provider service and accountability.

What TPAs and Regional Carriers Should Consider

Many of the same evaluation criteria apply if you’re a third-party administrator or regional insurance carrier, but your priorities may differ slightly.

If you are building network offerings for self-funded clients, your needs go beyond broad access. You need a partner who can help you deliver high-quality, high-performing networks across multiple employer groups, without adding unnecessary complexity or overhead.

Here are a few key capabilities to look for in a network partner:

Configurable Network Structures

The ability to customize networks by client, region, or industry, while maintaining consistent quality standards across the board.

System Integration and Scalability

Seamless integration with your eligibility, claims and care management platforms to minimize administrative burden and support scalability.

Multi-Client Visibility and Reporting

Access to reporting tools that allow you to monitor performance, cost and utilization across your book of business, not just one client at a time.

These considerations can help TPAs and carriers choose network partners that not only meet client needs, but also enhance operational efficiency and deliver long-term value.

Questions to Ask a Potential Network Partner

Once you’ve narrowed down your options, the next step is to ask the right questions. A strong network partner should offer more than broad access—they should be transparent, flexible, and aligned with your plan’s goals.

Here are three key questions to guide your evaluation:

How do you build and maintain your networks?

Dig into the provider recruitment and credentialing process. Ask how often networks are refreshed, what quality standards are used, and how the partner monitors performance over time. A good network isn’t static—it should be actively managed for quality, cost and member satisfaction.

Can your solution integrate with my existing TPA or care management vendor?

If you’re already working with a trusted TPA or vendor, you shouldn’t have to start from scratch. Ask how the network solution integrates with existing partners, including eligibility, claims and care management systems. True flexibility means your partners can work together—not in silos.

What visibility will I have into performance and utilization?

Look for tools and reporting that give you clear insight into how your network is performing. Can you see provider-level data? Are cost and quality metrics tracked over time? The more visibility you have, the easier it is to optimize your network and respond to emerging trends.

How are member disruptions and provider terminations handled?

Network stability is key. Ask about the process for notifying members, providing continuity of care, and onboarding replacement providers when contracts end or networks change.

Do you offer regional or industry-specific network options?

For employers or unions with members concentrated in certain areas or industries, a one-size-fits-all network may not work. Ask whether the partner can build or recommend targeted networks for your population.

What kind of support do you offer for members and HR teams?

It’s also worth understanding the level of service behind the network. Is there a dedicated support line for claims or eligibility issues? What resources are available to educate members and reduce confusion?

Building a Network Strategy That Works for Your Plan

Choosing the right healthcare network solution is about more than provider counts or pricing. It’s about aligning access, flexibility and performance with the unique needs of your workforce. By asking the right questions and evaluating how each network partner supports integration, visibility and member experience, you can build a strategy that delivers real value.

MagnaCare works with organizations across industries to design network solutions that reduce costs, improve outcomes and adapt as your needs evolve. If you’re looking for a smarter way to manage network access, contact us today to see how we can help.