As Pennsylvania officials have attempted to force Highmark into expanding its Medicare Advantage network, Highmark pushed back by claiming that the state lacks authority over the federal program.
The U.S. Departments of Labor, Treasury and Health and Human Services released a frequently-asked question document offering guidance on the use of reference pricing in non-grandfathered large group employer plans. This may be the first time the departments have tried to regulate group health plan network requirements under the Affordable Care Act according to a Health Affairs blog post by attorney Timothy Jost.
A think tank within the Department of Health and Human Services analyzed whether the agency should set new rules requiring stricter standards for provider networks on the health insurance exchanges, reported LifeHealthPro.
The pushback against narrow networks across the nation continues in the form of legal action as a consumer group filed lawsuits against Cigna and Blue Shield of California on Thursday.
There have been a lot of changes to Medicare Advantage plans of late--UnitedHealth dropped providers in Alabama, Humana lost a big provider contract and MVP Health Care is discontinuing two of its plans.
If insurers implement certain standards into their provider networks, they can help minority populations receive better care and thereby lower costs, according to a new issue brief from Families USA.
As the healthcare industry as a whole is moving toward a more consumer-centric mindset, this does not bode well for insurers who offer a list of only narrow-network providers.
Accountable care organizations often involve high-need, high-cost patients, which can make for a very expensive and challenging program to manage. But a team of researchers has identified effective ACOs that successfully implement complex care management (CCM) interventions that insurers and providers can use to bolster their own programs, lower costs and improve care.
While policies with limited networks of doctors and hospitals existed before the Affordable Care Act, the backlash has been growing against narrow networks since exchange coverage kicked in.
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.