May 02, 2016

Regulators React to Debate Over Narrow Networks

On April 4, CMS published its annual Call Letter for the Medicare Advantage and Part D programs. In it, CMS shared its intention to “aggressively identify and pursue instances of non-compliance” with provider directory accuracy standards. This warning, and corresponding initiatives in the Medicaid and commercial insurance markets, foreshadows a difficult year ahead, as regulators and health plans struggle to find the balance between transparency and choice on one side of the ledger and quality and efficiency on the other.

Mike Adelberg, senior director in Faegre Baker Daniels Consulting's Health and Biosciences team and former CMS official, authored an article in Managed Healthcare Executive discussing the relationship between regulators and provider networks as the industry continues through this period of dramatic change. Adelberg suggests that managed care industry leaders recognize existing tension between the parties and minimize avoidable issues, such as correcting errors in provider directories.

“As the research on provider networks matures, so will the debate,” Adelberg said. “Health plans will have the chance to help regulators consider emerging measures of network quality while complying with today’s measures of network adequacy.”

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