So, what should happen with narrow networks under the new administration? The reality is that health insurance premium inflation, the chief gripe of the ACA, will not attenuate until the cost of health care comes down. When it comes to controlling costs, narrow networks are an important element. And since people are generally happy with these networks, the focus should be on finding ways to improve the definition and utilization of them. Such improvements include:

Expanding the definition of network adequacy requirements. "Network adequacy" refers to a health plan's ability to deliver the benefits promised by providing reasonable access to a sufficient number of in-network primary care and specialty physicians. However, the scope of network adequacy needs to be expanded to include combinations of in-network providers, including specialists and hospitals, needed to treat certain conditions.
Improving interoperability of EMR platforms. Making patient health records accessible by physicians in different practices and systems will help with care coordination.
Expansion of "in-network" physician referral tools. Coordination of care, and, indeed, patient follow-through, suffer when physicians don't have tools to refer a patient to an in-network specialist. There are over 100 million annual referrals from primary care physicians to specialists and other providers, yet referral management tools that take patient network participation into consideration are few and far between. Easy to use tools, integrated into EMRs and practice management systems or stand alone, will markedly improve the patient experience, adherence and costs.
Continued improvement of transparency tools to help groups and individuals make good plan choices based on their preferred doctors and facilities. This may mean different plans for different family members to maximize inclusion of desired doctors for each.
Introduction of better tools to help individuals find new doctors that participate in their network and to alert them when one of their doctors stops participating in their network.

Repeal, replace, repair. Whatever happens with the ACA over the coming months and years, narrow networks should not disappear. They offer too much potential for controlling costs and coordinating care, without compromising on quality.

Instant Insights /

The future of narrow networks and the ACA

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