Physicians who want to participate in health payers' so-called narrow networks must know their market, according to a Medical Economics report.
These narrow network health plans, where payers limit consumers' choice of providers to those within the network, have become more common with the advent of healthcare exchanges under the Affordable Care Act. While physicians may want to participate in narrow networks, in some markets providers are feeling the pressure to accept significant reimbursement cuts to remain in a network, according to the article.
Physicians need to assess the market they are in and know which ones are under the greatest pressure to narrow providers as the system shifts to value-based pay, according to Medical Economics. Narrow networks are a reality and will continue in the future since they are tool for health plans to control costs, Anders Gilberg, senior vice president for government affairs at the Medical Group Management Association told the publication.
A concern for physicians are the lower reimbursement from payers in narrow networks. But physicians are not without negotiating power as plans need doctors to staff their narrow networks, Gilberg said.
Practices need to put themselves in a better position to demonstrate quality care, as alternative payment models being created under the Medicare Access and CHIP Reauthorization Act (MACRA) will eventually create more opportunities, Ashraf Shehata, a partner in consulting firm KPMG, told the publication. Here are a couple of steps practices can take to prepare:
Track cost and quality data to use during negotiations with payers, demonstrating that they have made investments in electronic health reports and quality reporting, Shehata said, as well as demonstrating what services they offer patients. Track quality measures that are important to patients such as the prevention of surgical site infections or medication errors, said Jonathan Gottlieb, M.D., chief medical executive for Indiana University Health, which recently cut the number of quality metrics providers track from almost 200 to 10.
Organize small providers into an informal partnership without formally taking the step to merge to boost negotiating power. Primary care and specialist groups can work together, but be aware of laws governing co-ownership and Stark law prohibitions, Shehata said.
To learn more:
- read the article