COVID-19 Update: Read our messages to employees and clients

COVID-19 UPDATE
April 17, 2015
The Skinny on Narrow Health Networks

The passage of the Affordable Care Act has resulted in many changes in healthcare management and insurance plans, not least of them being the increase in the phenomenon of “narrow networks.” These plans limit patients’ choices of primary care physicians, specialists and hospitals or other healthcare facilities, in return offering lower premiums that may appeal to individuals and families for their affordability.

These narrow plans are popular among consumers, but they also face opposition due to concerns from consumer groups that restrictions on provider choice that are not found in more-conventional plans — which cover most or all providers in a region — could limit access to needed services and, therefore, harm patient care. So what’s the truth? As usual, it lies somewhere in between the extremes. Here are four need-to-knows about narrow health networks.

1. Narrow networks are gaining in popularity. Currently, about 48% of marketplace plans could be classified as narrow. According to the Washington Postapproximately 70% of insurance plans sold on the ACA’s health insurance marketplaces this past year had narrow or ultra-narrow networks, defined as excluding at least 30 percent of an area’s largest hospitals.

2. There is growing consumer pushback against narrow network plans: patients have filed lawsuits over being left without coverage in the course of their treatment. According to Kaiser Health Network, these cases, which are seeking class-action status, allege that “insurers offered inadequate networks of doctors and hospitals and that the companies advertised lists of participating providers that were incorrect. Consumers learned their doctors were not, in fact, participating in the plans too late to switch to other insurers … and patients had to spend hours on customer service lines trying to get answers.”

3. Savings may not be so impressive over time for employers who shift employees over to narrow networks. Furthermore, the size of a plan’s network is not necessarily tied to premiums. The authors of a recent study for the Urban Institute found that although narrowing networks (i.e., limiting the amount of providers covered under a specific plan) generally led to more-competitive, lower-cost premiums, some plans with broader networks had low premiums and some plans with narrow networks had high premiums.

4. Structured correctly, however, narrow networks “can succeed in saving money and helping certain patients get appropriate healthcare,” according to a new study published by the National Bureau of Economic Research. Consumers who chose such plans “saved their employers money, saw their primary care doctors more and used the ER less,” according to the New York Times. In fact, spending fell by almost 40%, reflecting reductions in both quantity of services used and prices paid per service. Although spending on primary care providers increased, spending on specialists and hospital care more than made up for the rise. The best narrow plans should therefore offer sufficient access to front-line care, which would ensure high costs and low-quality care are avoided. For consumers “who know what they’re buying and are willing to trade away choice for lower premiums,” then, narrow networks can be the right option.

In short, narrow networks are not a return to the 1990s-style managed care that we saw with health maintenance organizations (HMOs), which were so thoroughly derided. Instead, narrow networks are part of a new era in health coverage, where pricing transparency is important and consumers are becoming more savvy. The enrollees who take the time to educate themselves can be rewarded without facing the prospect of lower-quality healthcare.

Care Navigators
As healthcare business models evolve, so should care teams.

Patients who are paired with Care Navigators report feeling less anxiety, and an increased ability to self-manage their conditions between visits. And providers report increased job satisfaction from improved efficiency, and knowing their patients have access to care teams, and strategic support.

LEARN MORE AT CARETHROUGH.COM
Chronic Care Management
With an increased aging population managing two or more chronic illnesses, extending your care teams’ ability to communicate with patients is critical. We take a strategic approach to helping patients chart a path towards their health goals, while self-managing their chronic conditions between clinical visits.

LEARN MORE AT CARETHROUGH.COM
Artificial Intelligence
Our advanced AI solutions tackle complex documentation challenges to reduce the administrative burden preventing doctors from delivering precision care. We'll guide you through the best practices for incorporating AI into your workflow. Gain visibility into your data with enhanced analytics driven by AI and CTAs.

LEARN MORE AT SOUNDLINES.COM
Nurse Care Team Assistants
Adding a qualified Nurse CTA to the care team increases quality of work-life and reduces stress on nurses. The nursing profession is also experiencing an alarming shortage due to increased clerical burdens and burnout.

LEARN MORE AT CARETHROUGH.COM
Revenue Cycle Management
Transition Revenue Cycle Management into the modern age with a suite of software tools that will transform your billing and coding processes. Transact at lightning speed, with increased transparency and decreased siloes. The QueueLogix software application seamlessly integrates with existing EMRs to ensure the clinical activities and back-office operations are well aligned, monitored and successful.

LEARN MORE AT QUEUELOGIX.COM
Referral Management
Referrals scheduled by navigators in the clinical setting builds long term, patient care integrity across the care continuum. With the authority, along with the provider to search for specialists in network, navigators assess their schedules, and ensure appointment compliance.

LEARN MORE AT QUEUELOGIX.COM
Scribe Services
There’s a reason why we’re the nation’s most frequently used scribe company: we offer professionally trained in-person and virtual medical scribes to meet the specific needs of our clients. We offer a variety of scribe programs, as well as technology and personnel solutions that address revenue cycle management, the transition to value-based care, and more through our HealthChannels family of companies.

LEARN MORE AT SCRIBEAMERICA.COM