What Are High-Performance Networks?

Key Takeaways

• A high-performance network is a narrow network the carrier curates with quality and cost data, so it still limits which doctors and hospitals employees can use.
• Employers can cut premiums with a high-performance network, but the savings come from restricting access to care, and that restriction creates employee friction and renewal risk.
• Instead of narrowing the network, employers can capture similar savings by steering care toward the best-performing doctors already in it, so employees give up nothing.

When a renewal quote comes back high, the option carriers increasingly put on the table is a high-performance network. A high-performance network (HPN) trades access for price. Employees accept a smaller roster of doctors and hospitals, screened on quality and efficiency, and the employer pays a lower premium in return. These plans are still new, but they're catching on, with 35% of large employers already offering one, according to Mercer's 2025 national survey.

The savings are real, but they aren't free. The plan gets cheaper by restricting where employees can go for care, and that restriction creates friction most renewal conversations never price in. Some of it lands on employees, who lose doctors and run into unexpected bills, and the rest comes back to the employer, because a plan that generates complaints gets harder to keep every year. There is also a growing case that employers can capture similar savings while leaving their network exactly as it is.

What is a high-performance network?

A high-performance network is a narrowed provider network that a carrier builds by selecting doctors and hospitals on quality and cost performance, rather than including its full contracted panel. The carrier screens providers on outcomes and efficiency measures, keeps the ones that score well, and designs the plan, so employees use that smaller group. Some designs steer care with tiered cost-sharing that makes the selected providers cheaper to see, while stricter versions drop out-of-network coverage for non-emergency care altogether.

High-performance networks are a subset of narrow networks, not a separate category. The label describes how the carrier picks providers, using performance data rather than unit price alone, but the product is still a network with fewer doctors in it. Strategy& describes the design as passing providers through three screens, starting with total cost of care across a full episode, then quality of outcomes, then consumer preference. A network built that way can genuinely end up with better doctors, but it is still smaller than the one employees had before.

The trade-off employers don't always see coming

The same Strategy& analysis found that narrow network products can cost as much as 35% less than traditional plan designs, and economists studying the CalPERS system found that narrowing a network would have let the plan negotiate hospital prices about 12% lower on average, with cuts up to 30% in some markets. Numbers like those explain why carriers keep building these products.

What gets less attention is how small the networks behind those numbers can be. In KFF's analysis of marketplace plans, the average enrollee's network included 40% of local physicians, and about seven in ten enrollees were in plans covering half or fewer of the doctors near their home. Employer versions usually keep more doctors in-network than marketplace plans do, but the savings still come from leaving providers out. Whoever gets left out is likely somebody's doctor.

For some workforces, particularly ones concentrated near the selected health systems, the trade-off can work. It is still a trade, though, and carriers spend far more time talking about the premium than about what employees give up.

What employees actually experience

Employees rarely get a warning that a longtime doctor is no longer covered. Most find out on their own, usually when they try to book an appointment, and then have to choose between starting over with a stranger and paying rates the plan may not cap. Checking ahead does not always help either, because the plan's directory is often inaccurate. And when the guesswork goes wrong, the bills can often be life-changing. CBS News reported on a Tennessee man whose high-performance plan initially refused to cover the only nearby neurosurgeon qualified to treat his brain aneurysm, a denial that ended in emergency surgery and months of uncertainty over six-figure costs.

Why the trade-off matters for advisors and renewals

Benefits advisors tend to be wary of solutions that create problems for employees, because those problems eventually become theirs. When employees complain about lost doctors and surprise bills, those complaints route through HR to the advisor who recommended the plan, and a product that saved money on paper starts costing credibility with the client.

The real test comes at renewal. A high-performance network that produced a year of complaints is a harder plan to defend in year two, and unwinding it means another round of ID cards, provider changes, and open enrollment messaging. Advisors who have lived through that cycle once tend to ask a different first question the next time, and that question is whether the savings require anyone to give something up.

Getting the same savings without narrowing the network

A carrier can only build a cheaper network out of an existing one because providers inside the same network already vary enormously on cost and quality. Research on doctor performance shows that which physician a patient sees shapes outcomes and total spend more than almost any other decision in an episode of care.

Theoretically, a high-performance network handles those differences by cutting the weaker performers out. However, when economists studied a high-performance network in the small-group market, they found that 96% of its savings came from selecting lower-cost providers. A network assembled that way can honestly claim cheaper doctors, but that says little about whether they are better ones. Removal is not the only answer, though. An employer can leave the network fully intact and steer care toward the best-performing doctors already in it, an approach built on shifting demand rather than shrinking supply.

Garner takes this second path. It works as an overlay on top of any existing plan or network, using provider-level quality data to identify the top performers in an employee's own network and a financial incentive that helps cover out-of-pocket costs when employees see them. It requires no network changes, and employees keep every doctor they have today. As care shifts toward doctors who deliver better outcomes at lower total cost, the plan saves money.

An independent actuarial analysis by Aon found that employers using this incentive-based model saw 7.4% lower medical spend on average in the first year against a matched control group, worth $345 per member per year, with no change to plan design or network. The same analysis found employers who pair the incentive with plan design changes can reach savings of 15% or more. Set next to the roughly 12% price reduction narrow networks negotiate by removing providers, steering earns its place in the same conversation while asking employees to give up nothing.

What this means for your next renewal

High-performance networks trade access for savings. Incentive-based steering earns savings by changing which doctors employees choose without asking anyone to give something up. Some doctors are much better than others, and both models are built on that fact. The difference is who pays for acting on it.

Before your next renewal, decide what you are willing to change. One model shrinks the network, and the other changes how employees move through it. If the goal is savings employees never have to feel, steering on an intact network fits better. With Mercer projecting employer health costs to rise 6.7% in 2026 even after plan changes, standing still is the most expensive option of all.

Curious what provider-level savings could look like on your existing network? Book a demo to see how Garner works without changing your plan.

FAQs

How is a high-performance network different from a regular PPO?

A regular PPO includes the carrier's full contracted panel and covers out-of-network care at a higher cost-share, while a high-performance network keeps only a screened subset of those providers and often covers little or nothing outside it. The PPO buys flexibility at a higher premium. The high-performance network buys a lower premium by giving that flexibility up, which is why the two products can sit on the same carrier's shelf at very different price points.

Do high-performance networks actually save employers money?

On average, yes. Strategy& found narrow network products can cost as much as 35% less than traditional designs, and research on the CalPERS system showed a narrower network could negotiate hospital prices about 12% lower on average. The savings depend on employees actually staying inside the smaller network, though. When care leaks out-of-network, or complaints push the employer to reverse course at renewal, the projected savings erode quickly.

What are the downsides of a high-performance network for employees?

The main downsides of a high-performance network are lost access to existing doctors, confusion about which providers remain covered, and exposure to large bills when care falls outside the network. Provider directories often lag the actual network, so employees can book care they believe is covered and learn otherwise from the bill. In the most restrictive designs, which drop out-of-network coverage entirely, a single misstep can turn into lasting medical debt.