Frequently Asked Questions
What is a provider network?
A provider network is a group of health care providers, such as physicians, hospitals and related medical experts, who are linked together to improve quality of care for patients. These providers make a commitment to work closely together to coordinate all aspects of a patient’s care, to make care seamless.
What is an Accountable Care Organization?
An Accountable Care Organization (ACO) is similar to a provider network in that it is a connected group of health care providers. However, providers in an ACO have also accepted responsibility for patient care and have financial accountability for those served by the ACO, in an effort to fulfill the Triple Aim. These providers form a “neighborhood of care” centered around the member to promote optimal health at every age and stage of that person’s life. By functioning as a team to seamlessly coordinate care, ACO providers are rewarded with shared financial incentives that are available only when quality of care and patient experience are improved, and cost efficiencies are achieved.
What is the Triple Aim?
The Triple Aim is a vision of health care delivery developed by the Institute for Healthcare Improvement and supported by our federal government to improve health care across our nation’s entire population. The Triple Aim suggests that health care must be high quality, provide a good patient experience and remain affordable. The providers in Banner Network Colorado have made a commitment to fulfill the Triple Aim.
Do providers in an ACO care for patients differently?
In order to work collaboratively to ensure a highly coordinated care experience, providers in an ACO often have access to certain resources to enhance health management for the populations they serve, including in-network specialists as needed, case management support, and electronic medical records to improve communication between providers on behalf of members.
Is an ACO the same as a Health Maintenance Organization (HMO), managed care or an insurance company?
No, a key difference is that an ACO is a provider network and not an insurance provider, though many ACOs like Banner Network Colorado have relationships with insurance companies to assure you can easily access our services. Additionally, HMOs are paid a fixed price per member regardless of the care provided, but ACOs are only rewarded financially if they achieve goals like improving the health of members, providing a good patient experience and improving the efficiency of care.
How many providers are in Banner Network Colorado?
More than 300 providers are currently participating in Banner Network Colorado.
How many people receive care from providers in Banner Network Colorado?
Banner Network Colorado is currently responsible for the care of more than 11,000 covered lives in the Colorado area. These individuals are considered members attributed to Banner Network Colorado, meaning they receive care from a Banner Network Colorado provider.
Do I need to have special insurance or pay any fees to be a member in Banner Network Colorado?
Beyond the normal insurance premiums or self-payments a patient might make to an individual provider, members do not pay any additional fees to be part of Banner Network Colorado. Banner Network Colorado has established relationships with most major insurance companies (also known as payers). Those payers include organizations like Aetna, Anthem, Cigna, Humana, and UnitedHealthcare.
What benefits do I receive by seeing a Banner Network Colorado provider?
Because Banner Network Colorado functions as an ACO, you receive the benefit of highly coordinated care, supported by a proven population health management model. In simple terms, your providers have access to a collection of resources to enable them to communicate easily and regularly with you and with one another about your care.
Do Banner Network Colorado providers only work with Banner Health facilities?
Banner Network Colorado has a relationship with Banner Health to utilize Banner hospitals in Larimer and Weld counties. We also have selected a variety of preferred care partners in the communities we serve with established quality of care performance and an active ongoing relationship with our care teams.
What major insurance companies (also known as payers) have relationships with Banner Network Colorado?
Aetna, Anthem, Cigna, Humana and United Healthcare currently have relationships with Banner Network Colorado. This list of relationships is expanding regularly.