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 Medicare Pioneer ACO?
The Pioneer Medicare ACO pilot was established through the Affordable Care Act (ACA) to test how effectively the ACO model could fulfill the Triple Aim. This pilot focuses specifically on Medicare beneficiaries to improve the quality and accessibility of care and reduce costs for this population specifically. Thirty-two health care organizations nationally were selected through a competitive process to test this model. Banner Health Network is one of those original 32 organizations.
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 Health Network 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 Health Network 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 Health Network?
More than 4,000 providers are currently participating in Banner Health Network.
How many people receive care from providers in Banner Health Network?
Banner Health Network is currently responsible for the care of more than 400,000 covered lives in the metro-Phoenix area. These individuals are considered members attributed to Banner Health Network, meaning they receive care from a Banner Health Network provider.
How can I find a Banner Health Network provider?
Go to our provider directory to find a Banner Health Network primary or specialty care physician.
Why should I choose Banner Health Network over other provider networks?
Banner Health Network is the state’s largest ACO and was the only one in Arizona to be selected to participate in the Medicare Pioneer ACO pilot by the federal government. The providers in Banner Health Network have tremendous experience and the Network itself is considered an industry leader among ACOs, with recognized proficiencies in delivering high quality and efficient care centered on the specific needs of the patient. Further, Banner Health Network offers a full complement of primary and specialty care, with access to renowned medical experts associated with Banner MD Anderson Cancer Center, Cardon Children’s Medical Center, Banner Behavioral Health Hospital and Banner Alzheimer’s Institute.
Do I need to have special insurance or pay any fees to be a member in Banner Health Network?
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 Health Network. Banner Health Network has established relationships with most major insurance companies (also known as payers). Those payers include organizations like Aetna, Blue Cross Blue Shield of Arizona, Cigna, Humana, Meritus and UnitedHealthcare.
What benefits do I receive by seeing a Banner Health Network provider?
Because Banner Health Network 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 Health Network providers only work with Banner Health facilities?
Banner Health Network has a relationship with Banner Health to utilize the hospitals and medical centers owned by the state’s largest health care system. Banner Health has significant reach across Maricopa and Pinal Counties, from Buckeye in the west to Queen Creek in the east, and from Surprise and Peoria in the north to Chandler in the south. We also have selected a variety of preferred care partners throughout the communities we serve with established quality of care performance and an active ongoing relationship with our care teams.
What provider groups participate in Banner Health Network?
The following groups comprise Banner Health Network:
- Arizona Integrated Physicians: AIP is a physician organization comprised of more than 1,000 physicians, including approximately 250 primary care physicians and 750 specialty care physicians. Founded in 1994, AIP is dedicated to becoming a virtual medical group and clinically integrated physician network that enhances the viability and sustainability of independent physicians. AIP is a DaVita Healthcare Partners company.
- Banner Medical Group: This is a group of more than 1,100 primary care and specialty physicians employed by Banner Health who practice in Banner Health clinics, multi-specialty Banner Health Centers or Banner Health hospitals.
- Banner Physician Hospital Organization: Originally formed in 1989 to represent the community physician, this independent physician-led organization participates in a variety of traditional and risk-based commercial and government contracts in order to deliver care to the residents of Maricopa and Pinal counties. Today, the group is 1000 physicians strong and growing.
- Banner Health: A nonprofit health system headquartered in Phoenix, Banner Health employs more than 39,000 employees and operates acute and specialty care hospitals, surgery centers, primary care centers, rehabilitation, home care, behavioral health, hospice care and more.
Does Banner Health Network only offer primary care, or does it also offer specialty care?
With more than 4,000 participating providers, Banner Health Network offers expertise across the entire health care spectrum to meet the needs of patients at every age and stage of life. In addition to a vast array of primary care providers and specialist physicians throughout Maricopa County, Banner Health Network also has affiliated providers who practice at recognized specialty facilities like Banner MD Anderson Cancer Center, Banner Heart Hospital, Cardon Children’s Medical Center, Banner Behavioral Health Hospital and Banner Alzheimer’s Institute.
What major insurance companies (also known as payers) have relationships with Banner Health Network?
Aetna, Blue Cross Blue Shield of Arizona, Cigna, Health Net, Humana and UnitedHealthcare currently have relationships with Banner Health Network. This list of relationships is expanding regularly. In addition, Banner Health Network works with government payers like the Centers for Medicare and Medicaid Services.