Tried and True, but Better:

Building a Modern Network Strategy

David Murtagh discusses how flexible, data-driven network strategies can help self-funded plans deliver greater choice, stronger cost control, and more customized benefits for today’s diverse workforce.

As healthcare costs continue to rise, employers look to self-funded health plans to gain greater control over spending and plan design. But while self-funding removes many of the costs associated with traditional insurance models, it also introduces a new challenge: balancing cost containment with employee access to care.

At the heart of that challenge sits one critical component—the medical network.

David Murtagh, General Manager of Network Solutions at Claritev recently shared “The medical network is generally at the center. The medical network is the foundation, and then you can have your varying point solutions and plan attributes built around it.”

The question for employers is no longer simply whether they have access to providers. It’s whether their network strategy enables flexibility, innovation, and meaningful cost management. That’s where PHCS Novera comes in.

PHCS Novera is a primary network solution combining strength with national coverage offering flexible option for third party administrators (TPAs) seeking to deliver value and choice to their clients.

Moving beyond one-size fits-all networks

One of the primary advantages of self-funding is the ability to design benefits around the unique needs of a specific employee population.

“This pool of 1,000 or 3,000 people is big enough that I can spread risk, but it also has its own unique attributes,” David says. “There are unique aspects of the plan design that I want to make sure reflect that.”

Yet many traditional network arrangements can limit an employer’s ability to customize benefits. In practice, this means employers may have fewer choices when selecting pharmacy benefit managers (PBMs), utilization management programs, navigation services, or other solutions helping manage costs and improve member experiences.

Flexibility as a competitive advantage

The next evolution of network design isn’t simply about creating narrower networks. It’s about creating smarter networks that provide employers
with more options.

“We’re trying to find that balance,” David explains. “Plenty of access without some of the other common restrictions.”

Rather than forcing employers into a predefined structure, a flexible network model allows TPAs and brokers to build benefit plans around each employer’s goals.

“It’s really up to the TPA to be as creative as they desire building around our medical network. Our goal is national flexibility—not hinder that creativity.”

This flexibility becomes especially valuable for employers with geographically diverse workforce. An employer may choose a more focused network arrangement in one market where they have significant employee concentration, while maintaining broader access in other regions. They can also tailor benefits differently for traveling employees, remote workers, and local populations.

“For instance, the flexibility of our PHCS Novera network allows an employer to make informed, decisions based on where their employees are located and how they want to customize specific populations.”

The access versus cost debate

Whenever employers consider a more focused network strategy, concerns about access inevitably arise.

“There’s always going to be concern anytime you don’t have access to every provider in a market,” David acknowledges.

However, access alone doesn’t necessarily translate into value.

“It might feel good that you have access to all four major health systems in a market,” he says. “But if two of them have much less competitive rates negotiated with the network, there’s no differentiation and no real clear way to steer members.”

The reality is that very few networks provide access to every provider in every market. The more important question is whether employers have the tools and incentives to guide members toward high-quality, cost-effective care.

A flexible network structure allows employers to determine how much they want to incentivize care decisions and how much access they want to maintain, creating a deliberate balance between member choice and financial performance.

Why health systems are engaging

For providers and health systems, participation is about more than reimbursement rates.

“We were founded as a network company,” David notes. “We have decades-long relationships with these health systems maintained through trust and collaboration, and PHCS Novera is a launching point for a broader effort of listening, learning, and investing further in that collaboration.”

Those longstanding relationships create opportunities to be more strategic.

“When we come and say we’re doing something really different with our network, providers are really interested in listening.”

At the same time, providers increasingly recognize the value of plans that actively guide patients toward participating facilities.

“This network has a stronger value proposition than our other networks,” David explains. “Employers that use this network are offering comprehensive ACA-compliant benefit designs, and are prepared to help steer members within the network. The combination of trusted relationships, competitive reimbursement arrangements, and member steerage creates a compelling proposition for both providers and employers.”

Data-driven network development

“Today’s network strategies are increasingly informed by transparency data and market analytics. Our Network Development team is probably the largest consumer
of price transparency data,” David says.

Rather than negotiating blindly, the team uses publicly available market transparency data as a starting point for provider discussions.

“At Claritev, we lead with transparency data because we can’t deliver on our end of the value proposition—steering membership—if our rates aren’t competitive.”

The objective is straightforward: create network arrangements offering employers confidence that pricing remains competitive within their markets while preserving provider relationships.

A new era of employer choice

Perhaps the most significant shift is what this means for employers, TPAs, and brokers seeking differentiation. Historically, network decisions often forced organizations into rigid structures with limited opportunities for customization. This emerging model flips that equation.

“That’s the value proposition,” David says. “You can differentiate yourself.”

In a market where employers are searching for ways to control costs without sacrificing employee experience, flexibility may become the most valuable benefit of all.

The future of self-funded healthcare won’t be defined solely by network size or provider counts. It will be defined by how effectively employers can combine
access, affordability, and innovation into a benefits strategy that works for their unique population.

And that starts with putting the right foundation at the center of the plan.