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.
As health insurers' provider networks get more narrow, many states are adopting standards to ease consumer concerns about limited selections of doctors and hospitals, reports The New York Times.
The shift toward value-based payment and increasing financial responsibility for consumers spur renewed interest in narrow networks. But for new narrow networks to thrive, they must have several key characteristics, Vanessa Pawlak and Matthew Fadel of Ernst & Young wrote in Becker's Hospital Review.
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.