I have heard rumblings about narrow networks since early 2013. Mostly the discussion was framed in terms of “one more thing everyone will hate about the Affordable Care Act.” Sarah Kliff of the Washington Post recently published a simple and comprehensive explanation of this “feature” of many exchange plans.
Just the name itself, a narrow network, sounds like a miserable, restrictive health plan that you would just as well avoid. But health-care experts love narrow networks, pointing out that they underpin some of the country’s most successful health plans.
Essentially, insurers are buying healthcare in bulk from a list of approved vendors. This gives them the leverage to get lower prices. Kilff points out that – as with many unpopular aspects of Obamacare – this approach is nothing new. Over the last few years, more and more payers are adopting this system, as shown by 2013 research from the Kaiser Family Foundation in the graph at the top of this post. According to a study by McKinsey and Co., about 70 percent of the plans on exchanges are narrow or ultra narrow.
With the Rise of AI, What IP Disputes in Healthcare Are Likely to Emerge?
Munck Wilson Mandala Partner Greg Howison shared his perspective on some of the legal ramifications around AI, IP, connected devices and the data they generate, in response to emailed questions.
The most important point that Kliff makes is this one:
It’s completely possible that cutting out an expensive hospital cuts out a top-notch provider. And, it’s equally possible that cutting out an expensive hospital eliminates a provider who charges excessive fees without delivering really great medical care.
This is why we need easy-to-understand, right-at-your-fingertips quality data for hospitals in particular and health systems in general. Medicare’s Hospital Compare site is a start, but 3 guesses at how much traffic that site gets (I bet only a few thousand visits a month). There are a few state efforts as well but they are not enough either. CMS is slowly releasing cost data. Hopefully that experience will make it easier to get the quality data (at some point in the not-too-distant future) as well.
If a person has only one or two hospitals to choose from in a narrow network, knowing which one does a better job caring for patients becomes a huge deal. Looking at this data will also help patients know what questions to ask of their surgeons and providers.
A Personalized Approach to Medication Nonadherence
At the Abarca Forward conference earlier this year, George Van Antwerp, managing director at Deloitte, discussed how social determinants of health and a personalized member experience can improve medication adherence and health outcomes.
Making quality and outcomes data easy to find and use will turn “consumer-driven healthcare” into a reality for everyone, instead of just code for “shifting costs to patients.”
