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Provider Networks

Latest Headlines

Latest Headlines

Cigna, Blue Shield of Calif. sued for 'bait and switch' scheme

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.

Medicare Advantage roundup: UnitedHealth, Humana, MVP Health Care make changes

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.

6 ways provider networks can help minorities access care

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.

Anthem Blue Cross slammed with narrow-network lawsuit

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.

5 complex care management methods to boost ACO success

​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.

Provider network complaints flood insurers

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.

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.

New standards could expand provider networks

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.

Narrow networks: 3 factors for success

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.

What it takes for high-value provider networks

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.