Narrow Networks: The Great Balancing Act

Health policy discussions in Colorado and across the nation are increasingly turning to the subject of network adequacy – the narrower networks that are one result of price-based competition in the insurance market.

The Colorado Health Institute has published a new report titled “Narrow Networks in Colorado: Balancing Access and Affordability.” It is the first in a series of reports planned on the subject of network adequacy.

We are seeing momentum in the state around this issue. Look for action from:

State regulators: The state’s Division of Insurance (DOI) last year commissioned a study of networks in the individual and small group markets, aiming to set a baseline for developing standards to evaluate network adequacy. The DOI plans to begin conducting stakeholder meetings during the summer with consumers, providers, insurers and policymakers.

Consumer advocacy organizations: Twenty Colorado consumer advocacy groups, led by the Colorado Consumer Health Initiative (CCHI), have urged state Insurance Commissioner Marguerite Salazar to support work by the National Association of Insurance Commissioners (NAIC) to revise the Network Adequacy Model Law. The group asked Salazar to “work within that process to ensure that consumers can obtain quality care in a timely, accessible and culturally appropriate manner.” It urged support of quantitative standards for network adequacy, stronger language on plan transparency and continuity of care provisions.

The Colorado legislature: A bill introduced by Democratic Sen. Irene Aguilar in the 2015 legislative session sought to protect consumers from some out-of-network charges, but lost on a party-line vote in a Senate committee. Consumers, insurers and advocacy groups spoke in favor of the bill, which Aguilar branded as “Know Before you Owe,” while physician and hospital groups opposed it. This bill or similar ones may be brought back in 2016.

Insurers: Insurers in Colorado will most likely continue to protect their flexibility to offer narrower networks in an ongoing effort to channel volume to specific providers, lower premiums and maintain quality.

Fundamentally, the debate is about balancing a diverse set of needs. The Colorado Health Institute, in this look at network adequacy post-Affordable Care Act, has identified three key questions facing policymakers:

• Are patients able to get the care they need when they need it?
• Do health plans have enough flexibility to develop products that meet customer needs at prices they can afford?
• Does the regulatory environment sufficiently protect consumers?

CHI launched a community discussion on Wednesday morning with a panel that featured Peg Brown, Deputy Commissioner for Consumer Affairs of the Colorado Division of Insurance; Adela Flores-Brennan, Executive Director of the Colorado Consumer Health Initiative; Janet Pogar, Regional Vice President, Provider Solutions, of Anthem Blue Cross and Blue Shield; and Dr. Mike Volz, President-Elect of the Colorado Medical Society.

Michele Lueck, our CEO, moderated the discussion.

It was clear from the discussion that this is an evolving issue which may very well be one of the great balancing acts in health care in the post-ACA world.