In the quest to lower costs and improve quality, health insurers increasingly are developing high-value provider networks. Many factors, including reimbursement structures and criteria for provider selection, contribute to successful high-value networks, according to a new report prepared for America's Health Insurance Plans.
Instead of outright excluding expensive providers from their health plans via narrow networks, insurers can sort providers into tiers based on cost-efficiency and quality performance measures to curb ever-rising healthcare costs, Meredith Rosenthal, associate professor at the Harvard School of Public Health, said at the AHIP Institute in Seattle.
While narrow provider networks may lower premiums, they have the potential to limit access to care and increase out-of-pocket costs. So it's still uncertain if narrow network plans can work under the Affordable Care Act, according to a new policy brief from the Urban Institute.
Some insurers' narrow networks include a mismatch among providers where in-network doctors don't have privileges at any of the in-network hospitals.
Narrow networks have become the favorite among insurers selling plans on health insurance exchanges. Now, insurers need to help convince consumers that they don't need more provider choices and it's better to save money instead.
To compete on premium price in the healthcare market, payers are turning to narrow provider networks. As this trend continues, many states are assessing their next moves to determine which actions will ensure access to care, reports AMA Wire.
The Washington state insurance department has adopted a new rule requiring insurers incorporate certain adequacy standards in their provider networks.
Following UnitedHealth's controversial move to drop 19 percent of its Medicare Advantage network, new rules call for insurers to give members and providers more notice of major network changes and terminations, Kaiser Health News and the Washington Post reported.
Provider networks on insurance exchanges exclude some of the nation's best cancer hospitals, which concerns some state insurance regulators and patient advocates.
The National Committee for Quality Assurance wants to overhaul its health plan accreditation program to better align with market and stakeholders needs. With that in mind, the proposed changes focus on provider networks and transparency.