How to form high-quality narrow networks


Despite public controversy over narrow networks, plans with smaller networks aren't necessarily bad, according to Ezekiel Emanuel, a former White House health adviser. Emanuel, who helped design the Affordable Care Act, says there are four features that can make for high-quality narrow networks, The New York Times reported, including these three:

1. Adequacy standards

Health exchanges should establish a minimum level of adequacy for provider networks to ensure all geographic areas have enough of each provider type. To avoid restrictive provider networks where insurers only use cost to select providers, the American College of Physicians (ACP) proposed standards to assess provider network adequacy, including patient-to-physician ratios and use of out-of-network providers as indicators of access, FierceHealthPayer previously reported.

Meanwhile, a bill moving forward in the Mississippi House would require insurers to accept into their network any healthcare provider who meets contract terms.

2. Transparency

Insurance companies should have to disclose how they choose their networks, such as what factors make a provider "high performing" or "efficient," according to Emanuel. Moreover, "the size of a plan's network should be as transparent as its premium," he wrote in the NYT.

Proposed legislation aims to enhance network transparency of Maine's health insurers by requiring insurers to clearly demonstrate in marketing and informational materials which hospitals they exclude from plans. The ACP's proposed standards also focus on increasing transparency, as it would make insurers explain why they drop doctors from their networks.

3. Evaluations  

Emanuel also called for better ways to measure the quality of doctors and hospitals included in networks. He suggested an A-through-F grading system that a group like the National Committee for Quality Assurance or Consumer Reports could develop. Most plans sold through health insurance exchanges limit patient choice of doctors and hospitals, so reliable quality evaluations could help consumers compare different plans.

For more:
- here's the NYT article

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