Blues exec: Smaller networks can improve care quality, lower costs

In response to consumer demands for quality care at an affordable price, many insurers are taking note and doing what they can to balance quality with price, Henry Smith, senior vice president of operations and chief marketing officer with BlueCross BlueShield of Tennessee, writes in The Tennessean.

Insurers are spear-heading the effort to meet consumer price demand by contracting with providers to create health networks, Smith writes. By getting doctors, hospitals and clinics to join, providers can accept discounts from their standard billing rates, thus saving members money by becoming a "value" network. Insurers are able to provide even more savings to their members by creating narrow networks that limit the number of care providers and negotiating rates to hold down costs, he says.

However, narrow networks have come under scrutiny, with a recent analysis finding that some Affordable Care Act exchange plans lack in-network doctors in key specialties. And a new model state law from the National Association of Insurance Commissioners proposes that instead of putting the cost burden on patients for out-of-network care, providers and insurers should settle the discrepancy in a mediation process.

But an analysis of narrow networks on the Covered California health plan marketplace found that in most cases, consumers don't need to worry that they are trading quality of care for lower costs. 

Indeed, Smith points out that BCBS of Tennessee chose the providers in its new "essential" network, called Blue Network E, based on not just price but also on their commitment to innovation and value-based reimbursement. The network, which is available in three Tennessee cities, contains one major in-network health system per city for those who choose a smaller-network option.

"Focused networks offer high-quality care at a lower cost than broader networks do, and those who enjoy the full benefits of their coverage are the ones who educate themselves about their options on the front end," Smith writes.

To learn more:
- read The Tennessean article