Narrow networks perform balancing act with access to specialty care

July 18, 2014

Networks must have ‘safety valves’ for assuring members have access

Narrow networks have attracted some negative attention lately, with the latest being reported that these networks present challenges with regard to accessing specialty care.

Physicians are reporting issues over making referrals for patients who have purchased some of the lower- cost plans under the ACA; they are also trying to determine what specialists accept the plans.

“The biggest issue with narrow networks is balancing the size of the network with access to care,” says MHE advisor Don Hall, principal, DeltaSigma, LLC, Littleton, Colo. “If access to providers is impeded, the result could be delayed care and higher costs because patients are sicker when they final get care-the exact opposite of why the narrow network was created."

Narrow networks need to have ‘safety valves’ for assuring members access to care, according to Hall.

“These could include employing provider schedulers whose only job is getting members into specialists, offering 24/7 telemedicine and providing in-home care,” he says.

According to John Santilli of Access Market Intelligence, which provides market intelligence to the pharmaceutical and healthcare industries, everyone is paying a price in today’s competitive healthcare market.

“Insurers, now competing on price, need to control the costs of the care that their customers use through the implementation of narrow networks,” Santilli says. “Consumers are learning that giving up choice results in lower premiums. Providers out-of-network will possibly see a market share decrease. In-network providers will experience a decrease in commercial payer rates. Will the government offer more relief to consumers by further regulating insurers’ contracting practices?”