The right network for the population.
Network strategy is one of the biggest levers in a self-funded plan. CGS Health designs around your members' geography, utilization, and budget — national, regional, direct-to-provider, wrapped, or reference-based — rather than forcing everyone into a single national PPO.
National & direct networks we build on.
We place each group on the network that fits its footprint — broad national PPOs for distributed workforces, and high-value direct and regional networks where members are concentrated.
A broad national PPO for distributed workforces — deep provider access across the country with the contracting strength of one of the largest carriers. Our most common foundation for major-medical plans.
National Blue-branded PPO access for groups whose members favor Anthem providers and facilities. A strong alternative national foundation with wide reach and recognized provider relationships.
A direct-contracted network built around Northwell Health's system in the New York metro and Northeast. High-value, system-level pricing and care coordination for groups concentrated in the region.
A regional network with strong local contracts and provider relationships across the Midwest. The right fit when your members actually live and work where Midlands has the deepest reach.
One of the largest independent PPO networks in the country — its PHCS network is most often layered as a complementary wrap to extend in-network access wherever a primary network is thin. Ideal for members who travel or live outside a regional footprint. (MultiPlan is now part of Claritev, but the network is still branded MultiPlan/PHCS.)
Two ways to extend value beyond a single network.
A primary network, wrapped for the gaps.
When a regional or direct network gives the best value in-area but doesn't reach everyone, we wrap it with a secondary network so traveling and out-of-area members stay in-network everywhere they go.
- Best-value primary network where members are concentrated
- National wrap for travel, remote, and out-of-area care
- Seamless member experience — one plan, one ID card
- Captures regional savings without sacrificing access
Pay a defined, defensible price.
Instead of discounting off inflated billed charges, RBP reimburses providers at a transparent multiple of Medicare — with member advocacy and balance-bill protection built in so members are supported, not surprised.
- Medicare-referenced reimbursement methodology
- Member advocacy and balance-bill support included
- Significant savings versus traditional PPO discounting
- Can run standalone or paired with a network
Custom structures on top of any network.
Tiered & steerage
Designs that reward members for choosing higher-value providers — lower cost-share for the best facilities, built to your plan.
Narrow & high-performance
A curated subset of top-performing providers for better outcomes and tighter cost control where the population supports it.
Custom regional builds
Layer the networks above by geography and benefit tier to match exactly where and how your members get care.
Built around your population — in three steps.
Map the population
We start with where your members live, work, and get care — geography, density, and historical utilization drive the network shortlist.
Model the options
We compare national, regional, direct, wrapped, and RBP scenarios on access and projected cost so the trade-offs are clear before you decide.
Build & steer
We implement the chosen structure — including tiering and steerage — and keep optimizing it as your population and claims evolve.
Let's model the network strategy for your group.
Tell us about your population and we'll show you the access-and-cost trade-offs across national, regional, direct, wrapped, and reference-based options.
