AHIP: Doc shortages drive network adequacy concerns

Doctor looking at a phone

Physician supply rates are dipping below the national average in a number of states across the country, particularly within specialties such as mental health and primary care, according to an analysis by America’s Health Insurance Plans (AHIP) that highlights network adequacy concerns insurers are likely to face in the coming years.

Fourteen states have specialty physician supply rates that fall below 90 percent of the national average, including seven states that fall below 80 percent. Psychiatrists have notably low rates in four states where the supply rate dipped below 60 percent of the national average. A recent report by the Association of American Medical Colleges (AAMC) indicates those figures are likely to worsen by 2025, particularly among surgeons and primary care physicians.

For insurers, the physician shortage complicates compliance with new network adequacy requirements. In order to adequately measure state-level network adequacy, AHIP says regulations should account for “differences in physician supply and distribution” and additional research is required to “prevent situations in which it may be impossible for health plans to meet adequacy standards in specific areas.”

Expanding the use of telemedicine and allowing practitioners and physician assistants greater latitude to care for patients are potential solutions to physician shortages in hard-hit areas of the country, according to AHIP. Additionally, the organization recommends offering loan repayment for physicians in underserved areas and simplifying the process for physicians in other countries to practice in the U.S.

Experts have highlighted telemedicine as a potential solution to network adequacy requirements, but insurers are still uncertain about regulatory requirements of the new industry. Meanwhile, states like Georgia, Maryland and Colorado have already begun stepping up network adequacy oversight.

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