Ex­perts de­bate stronger nar­row-net­work rules

Modern Healthcare - - THE WEEK AHEAD - —Paul Demko

Health plans with nar­row provider net­works have sparked broad con­tro­versy among health­care providers and con­sumers. In­sur­ers and em­ploy­ers are re­ly­ing on them to keep pre­mi­ums down and en­sure qual­ity, fol­low­ing ex­perts who say such “value net­works” are ef­fec­tive and nec­es­sary. But some pa­tients com­plain when they learn their pre­ferred doc­tors or hos­pi­tals are out of net­work or they can’t ac­cess the most highly rec­om­mended spe­cial­ists.

Last month, Cal­i­for­nia law­mak­ers passed a bill re­quir­ing in­sur­ers to pro­vide an­nual re­ports to the state about their net­works, with state reg­u­la­tors pub­licly post­ing their as­sess­ments of those net­works’ ad­e­quacy. Mul­ti­ple law­suits have chal­lenged the com­po­si­tion of net­works of­fered by An­them Blue Cross.

The Na­tional As­so­ci­a­tion of In­surance Com­mis­sion­ers is up­dat­ing its model net­work-ad­e­quacy reg­u­la­tions for states, with the model rules ex­pected in Novem­ber. And the CMS has in­di­cated it will heighten its scru­tiny of ex­change plan provider net­works.

On Fri­day, the Al­liance for Health Re­form will host a fo­rum on the is­sue on Capi­tol Hill. Among the sched­uled speak­ers are for­mer HHS Sec­re­tary Michael Leav­itt; Stephanie Mohl, se­nior gov­ern­ment re­la­tions ad­viser for the Amer­i­can Heart As­so­ci­a­tion; and Marc Bar­clay, vice pres­i­dent of provider net­works at Blue Cross and Blue Shield of Ten­nessee.

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