April 18, 2016

Provider Networks Take Center Stage: Emerging Trends and Oversight


Health plan networks are narrowing. While there are a number of good reasons for this trend, there is also worry that some networks have narrowed to the point that some members cannot easily access covered services. In response to unflattering reports and audits, regulators, including Departments of Insurance and the Centers for Medicare and Medicaid Services, are issuing stricter guidance and employing new oversight tactics to more assertively oversee provider networks and provider directories. 2016 is likely to be a year of heightened regulatory activity. 

Please join Michael S. Adelberg, who led provider network policy and oversight for both Medicare Advantage and the Exchanges at the Centers for Medicare and Medicaid Services (CMS), as he discusses:

  • The trend toward narrow network health plans
  • Findings and concerns from government auditors and other researchers
  • New and emerging guidance and oversight tactics for the Exchanges, Medicare, Medicaid and commercial markets
  • Strategies that can be employed by health plans and providers to stay on the right side of emerging oversight


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