As the use of narrow provider networks expands, political attacks and provider push-back has also started to grow.
While the current emergence of narrow networks has not incited widespread consumer backlash, these network models have started to become a political hot button. Some providers have expressed concerns about narrow networks hurting physicians who won’t accept significantly lower payments.
The Obama administration stated they would wait for the National Association of Insurance Commissioners (NAIC) to finish drafting a model state law before they propose a rule about network adequacy. The NAIC drafted an updated model state law in November 2014 and accepted comments through this past January.
Combining cost and quality as the qualifications for narrow network inclusion seems to be a way the successful networks are trending. Accountable Care Organizations frequently limit their provider networks, and they are incentivized to base their decisions not solely on cost, but also on patient outcomes. Providers on the outside looking in to ACO narrow networks can’t simply buy their way in by lowering their prices. If these providers want into a narrow network ACO, they may need to take part in creating one.
For health care consumers, the narrow network value equation is a function of two variables: “How much will it cost?” and “Can I see my doctor?” If both answers are positive, choosing a narrow network is a no-brainer. But if consumers one year can visit their preferred physician or facility and the next they can’t, narrow networks may see a drop in popularity.
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