HPN stands for High-Performance Network, a specialized type of provider network designed by insurance carriers. These networks are intentionally curated subsets of doctors, specialists, and hospitals. HPNs aim to address the rising cost of healthcare by focusing on both quality and efficiency.
Understanding High-Performance Networks
A High-Performance Network is a carefully assembled group of healthcare providers chosen from a much broader pool, such as a large Preferred Provider Organization (PPO) or Health Maintenance Organization (HMO) network. The primary goal of an HPN is to deliver high-quality patient care while simultaneously controlling the total cost of that care. This is achieved by entering into specific agreements that incentivize efficient performance and better patient outcomes.
HPNs are often utilized by employers or insurers as a strategy to offer benefit plans with lower monthly premiums. By limiting the provider choice to only those who demonstrate “high performance,” the insurer can negotiate better prices and reduce unnecessary utilization of services. This network structure moves away from the traditional fee-for-service model toward a value-based care approach. The result is a network that is typically more restricted in size—a “narrow network”—but is optimized for value.
While a standard PPO offers wide access, an HPN often functions more like an Exclusive Provider Organization (EPO). Services are only covered if they are received from within the HPN, except in emergencies. This limited access gives the insurer leverage to negotiate and enforce performance standards with the participating providers. The network’s success relies on a collaborative approach between the insurer, the providers, and the employer to maximize the benefits of coordinated care.
The Selection Criteria for HPN Providers
The “High-Performance” designation is determined by a rigorous, data-driven evaluation process that assesses both the quality and the efficiency of care. Insurers use a variety of metrics to select providers who meet strict benchmarks for inclusion in the network. This mechanism of selection is what distinguishes an HPN from a simply narrow network.
Quality metrics focus on patient outcomes, which are measurable results demonstrating the effectiveness of the care provided. These include lower rates of hospital readmission, adherence to evidence-based clinical guidelines, and improved patient health management for chronic illnesses. The use of nationally recognized clinical measures helps establish provider accountability for better patient outcomes.
Efficiency metrics evaluate how effectively a provider manages the cost of care delivery. This involves analyzing factors like the cost per episode of care, appropriate utilization rates for expensive services, and the avoidance of unnecessary tests or procedures. Providers who consistently deliver good patient outcomes without excessive spending are considered high-value and are prioritized for inclusion in the HPN.
The performance of hospitals, specialists, and primary care physicians is measured both individually and at an aggregate network level. This granular data analysis allows the insurer to identify opportunities for improvement and to recognize and reward those providers who consistently offer the highest-value care. To remain in an HPN, providers must continually meet these quality thresholds and efficiency standards.
How HPNs Affect Your Healthcare Costs and Access
The primary appeal of an HPN for policyholders is the potential for lower financial outlay compared to traditional, broad-network plans. HPNs commonly feature lower monthly premiums, resulting in substantial savings over the course of a year. Because the insurer has negotiated more favorable rates with the selected providers, patients may also benefit from lower out-of-pocket costs, such as reduced copayments or deductibles, when they access services within the network.
However, the cost savings are directly tied to a limitation in choice, which is the trade-off for the lower premium. HPNs typically function as in-network-only plans, similar to an Exclusive Provider Organization (EPO). If a member chooses to receive non-emergency care from a provider who is not part of the specific High-Performance Network, the health plan will likely offer no coverage, leaving the member responsible for the entire bill.
The restricted access requires patients to be diligent about confirming a provider’s network status before receiving treatment. Even if a specialist previously accepted the same insurance company’s standard PPO plan, they may not be included in the more selective HPN. While emergency and urgent care services are generally covered outside the HPN, all routine and specialized care must be sourced from within the curated network to receive benefits. Verifying network participation for every service is critical, as seeking care outside the designated HPN can lead to substantial financial exposure.