To compete on premium price in the healthcare market, payers are turning to narrow provider networks. As this trend continues, many states are assessing their next moves to determine which actions will ensure access to care, reports AMA Wire.
In Nevada, physicians are voicing their concerns about adopting narrow networks in their state. "Nevada presently has a severe shortage of both primary care physicians and specialists, which at times makes it difficult for patients to access appropriate care," the Nevada State Medical Association (NSMA) wrote in a Feb. 28 letter to the insurance commissioner, according to AMA Wire.
Patients who require acute care may be in trouble, since insurers that once included out-of-state physicians in their networks no longer do so. The NSMA plans to team up with the Nevada Division of Insurance to better regulate these decisions.
Late last month, the Washington state insurance department adopted a new rule requiring insurers to incorporate certain adequacy standards in their provider networks. The new rule states that insurers must include enough doctors and facilities in their networks to avoid delays in care, FierceHealthPayer previously reported.
But the Washington State Medical Association opposes the rule. "The language ... fails to adequately protect negotiations between insurers and physicians," WSMA President Dale Reisner, M.D., said in a letter to the commissioner. "Furthermore the new rule does not contain the strong provisions needed to ensure patient access across the state to all categories of providers and services," notes AMA Wire.
Connecticut legislature in February introduced a bill to add transparency to insurance networks, hoping to ensure a sufficient number of physicians for all patients, according to AMA Wire. Former White House Health Advisor Ezekiel Emanuel mentioned transparency as a main feature that can make for high-quality narrow networks. "The size of a plan's network should be as transparent as its premium," he wrote in a recent New York Times piece.
When it comes to group plan markets, narrow networks are flying low on the radar screen, especially since they were rejected back in the early 2000s, according to Medscape. Many observers believe the only way to escape narrow networks is to transition to accountable care organizations.