Contributor: Network Integrity as a Strategic Lever—Aligning Ambulatory Operations with Managed Care Success

A Blind Spot in Managed Care Strategy

In a recently published opinion piece for The Washington Post,¹ Ezekiel Emmanuel, MD, PhD, offers 5 strategies for controlling health care costs amid ongoing national debate over affordability.¹ From site-neutral payments to episodic and quality-based payments, the associated hundreds of billions of dollars in savings have a common dependency: the ability to deliver patient care and manage a population across a network of resources.

According to a 2025 survey of 142 health care organizations (including health systems and accountable care organizations), more than 60% reported increasing their participation in value-based care (VBC) programs, with 30% attributing at least 25% of their revenue to VBC contracts and 13% exceeding 50%.² This stands in contrast to a survey of health system executives in which 65% say leakage prevents them from reaching financial goals and 27% report leakage has increased since the pandemic.³

As health systems double down on VBC and managed care arrangements, the strategic conversation often centers on contracts, risk corridors, and population health infrastructure. Yet one of the most critical—and overlooked—drivers of success lies in the operational trenches: network integrity. The term rarely appears in boardroom discussions, but its impact is profound. Network integrity—the ability to keep patients within a high-performing, aligned network of providers—is not just a referral management issue. It’s a strategic lever that directly influences cost containment, quality performance, and patient experience. Strengthening network performance and connectivity offers a competitive advantage in rate negotiations for any given plan year, underscoring its strategic value in both upstream and downstream performance. In an era where leakage, fragmentation, and misaligned incentives threaten the viability of risk-based models, network integrity deserves a seat at the strategy table.

Defining Network Integrity in a Managed Care Context

Network integrity refers to the extent to which patients receive care within a preferred, strategically aligned network of providers. It encompasses more than just minimizing out-of-network referrals and includes:

• referral appropriateness and alignment
• provider incentive structures
• access optimization across ambulatory settings
• data interoperability and closed-loop communication

In managed care environments where entities share financial and clinical accountability, the ability to maintain network integrity becomes essential to execute strategic goals.

Why Network Integrity Matters More Than Ever

Managed care success hinges on 4 pillars: cost management, quality performance, patient experience, and population health. Network integrity supports each.

For care delivery networks, risk-based models mean taking ownership for healthier outcomes and lower costs, and failures in network performance undermine both. According to a 2022 CDC report, 8.3% of men and 12.8% of women in America could not find an available appointment when needed.⁴ The result: deferred preventative care that leads to increased acuity and expense. Further, a Journal of the American Medical Association meta-analysis suggests $27 to $28 billion in waste specifically attributed to failures in care coordination.⁵

Without a strong network of integrity strategies, even the most sophisticated managed care models can falter under the weight of fragmentation and inefficiency.

Common Gaps and Organizational Blind Spots

Despite its importance, network integrity is often undermined by:

• siloed referral processes that lack visibility and accountability
• misaligned incentives between employed and affiliated providers
• underutilized in-network capacity, leading to unnecessary leakage
• limited access in key service lines, pushing patients out of network
• inadequate data infrastructure to monitor and manage network performance

These are not just operational gaps—they are strategic liabilities.

Building a Network Integrity Strategy

To elevate network integrity as a strategic priority, organizations must invest in:

• Data Infrastructure: referral analytics, leakage dashboards, and predictive modeling
• Governance Models: cross-functional teams to oversee network performance and alignment
• Incentive Design: compensation structures that reward in-network utilization and shared outcomes
• Access Optimization: expanded hours, virtual care, centralized scheduling, and capacity planning
• Provider Engagement: education and alignment around managed care goals and referral pathways

Conclusion: From Operational Fix to Strategic Advantage

Network integrity is not just a back-office concern, it’s a strategic imperative. As health systems take more risk and seek to deliver on the promise of value-based care, the ability to keep care aligned, efficient, and in-network will define success. Leaders who recognize and act on this will be better positioned to thrive in the next era of managed care.

References

1. Emanuel E. America desperately needs new health care ideas. Here are five. The Washington Post. December 2, 2025. Accessed January 22, 2026. https://www.washingtonpost.com/opinions/2025/12/02/democrats-affordability-health-care-obamacare/
2. Innovaccer, NAACOS. The state and science of value-based care 2025. Innovaccer. Accessed January 22, 2026. https://www.naacos.com/wp-content/uploads/2025/05/State-and-Science-of-VBC-2025.pdf
3. Patient leakage & keepage report 2021–22. ABOUT Healthcare. 2022. Accessed January 22, 2026. https://abouthealthcare.com/reports/patient-leakage-keepage-report-2021-22/
4. Ng AE, Adjaya-Gbewonyo D, Dahlhamer JM. Sociodemographic differences in nonfinancial access barriers to health care among adults: United States, 2022. Natl Health Stat Report. 2024:(207):10.15620/cdc/158782. doi:10.15620/cdc/158782

• Shrank WH, Rogstad T.L, Parekh N. Waste in the US health care system: estimated costs and potential for savings. JAMA. 2019;322(15):1501–1509. doi:10.1001/jama.2019.13978

The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the opinions, position, or policy of Berkeley Research Group, LLC or its other employees and affiliates.