Narrow networks: Striking the right balance


Interest in narrow networks has grown along with concerns about limited provider choice and treatment disruptions. To eliminate those issues, narrow networks must achieve a balance among value, access and affordability, industry leaders said Monday at a briefing from the nonpartisan Alliance for Health Reform in the District of Columbia.

The panel featured leaders representing a nonprofit health system, health insurers, insurance commissioners and a healthcare economist, who all agreed that narrow networks aren't going anywhere and shared ways to strike the right balance.

For narrow networks to really foster high-quality, low-cost care, consumers need sufficient information, such as which doctors are included and how to access out-of-network care when needed. Health plans also need to notify consumers in a timely manner about any changes to provider networks.

"You can't have a free market if people cannot get access to information," said Brian Webber, the National Association of Insurance Commissioners's manager of health policy and legislation.

For the next open enrollment period beginning in November, payers need to do better at making sure everybody--patients and providers--have clear access to necessary information to know who is in-network and who's out.

Ascension Health echoed calls to better inform newly insured consumers about provider participation in networks. Ascension's Chief Financial Officer Katherine Arbuckle added that health plans must offer information that's more robust than just physician directories to enable consumers to compare providers.

While health plans support such enhanced transparency to help consumers make smarter decisions about where to seek care, Daniel Durham, executive vice president for policy and regulatory affairs at America's Health Insurance Plans, said informing consumers is a two-way street. For example, providers need to communicate with health plans if and when a provider no longer takes new patients.

While narrow networks have critics worried about care disruptions, Arbuckle and healthcare economist Paul Ginsburg, Ph.D., praised the models for fueling clinical integration. For instance, in-network providers can openly and easily communicate about patient care.

The panelists also cited the importance of flexibility in making narrow networks benefit payers, providers and patients. They must have the flexibility to reflect state needs and differing insurance marketplaces.

"We don't want it one-size-fits all," said Webber who noted that Wyoming is a "tad different" than Los Angeles.

Flexibility also allows insurers to take into account different patient populations when establishing networks with sufficient numbers and types of providers. With many low-income families signing up for exchange plans, just measuring the distance to a hospital in miles won't be enough to determine network adequacy if many of those patients lack transportation, Arbuckle noted.

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