Provider networks can help members obtain specialty care

Insurers' provider networks can help patients obtain safe and affordable specialty care when they include a range of specialty doctor and hospital groups with a history of delivering high quality care, according to a new report from America's Health Insurance Plans (AHIP).  

Because care that's delivered at specialty hospitals or physician practices is often more expensive than the same services provided at non-specialty facilities, including these specialty providers within networks is so important to help members access the treatment at more affordable prices, AHIP determined.

The report also found that as insurers have been internally designating centers of excellence and implementing third-party standards, their provider networks have increasingly enhanced their specialty care doctors and hospitals. And that helps ensure that members with specialty care needs can see the most appropriate, and affordable, doctor.

These findings come amid heightened scrutiny of narrow networks, which are widespread among plans sold on health insurance exchanges. Although narrow network plans offer far fewer providers for consumers to choose from, studies have found that they still deliver similar or better quality care as other plans. What's more, a large majority of consumers enrolled in exchange plans or are newly insured through Medicaid are either "very" or "somewhat" satisfied with their coverage.

However, AHIP warned that policymakers and regulators are considering proposals that would prevent insurers' flexibility to determine which specialty providers are in their network. If proposals are passed, insurers' ability to manage their networks will be limited.

To learn more:
- here's the AHIP report

 

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