Today, health plans are doing all they can to hold down premiums against a backdrop of aging members and increasingly expensive therapies, particularly biologics and other specialty drugs. A widely used cost containment method is narrowing provider networks.
Narrow network health plans are based on a simple trade off: In exchange for a lower premium, the consumer has access to fewer providers. However, there have been complaints that consumers do not know what they are buying, and a string of government audits reveal shortcomings in the accuracy of provider directories. Regulators are taking a fresh look at the potential downside of the narrow network trade off, and the regulation of provider networks is emerging as one of most contentious issues in health insurance.
In an extended article appearing in Compliance Today, Mike Adelberg examined narrow network health plans, commenting on their current role in the marketplace and future outlook. Adelberg, senior director in Faegre Baker Daniels Consulting’s health and bio sciences practice, also offered suggestions compliance departments can heed to be properly engaged on provider network issues.