Health Plans, Providers Increasingly Partner on Narrow Network Plans

Insurers and providers increasingly are entering into partnerships to offer health plans with narrow provider networks, Modern Healthcare reports.

According to Gerald Kominski, director of the UCLA Center for Health Policy Research, the trend mostly is the result of the Affordable Care Act. He said, “If you’re competing on price and you can’t vary copayment structure or deductibles, the only thing you can do is try and keep your networks as affordable as possible.”

In addition, other reasons cited by stakeholders for narrow network partnerships include:
-Providing a network patients can trust;
-Removing patients’ financial barriers to care;
-Incentivizing the proper patient behavior; and
-Enhancing data analytics by combining providers’ data with that from insurers.

Modern Healthcare listed several examples of recent provider-insurer narrow network partnerships:

-California-based Anthem Blue Cross and seven health systems in the Los Angeles area, which announced the formation of a joint venture HMO in September in an effort to increase competition with narrow network plans such as Kaiser Permanente;
-Minnesota-based Mayo Clinic and Medica, which will offer a narrow network health plan for 2015, available on Minnesota’s insurance exchange and through the off-exchange individual market; and
-Wisconsin-based health system Aspirus and insurer Arise Health Plan — both not-for-profits — which this week announced a health plan for individuals and companies with fewer than 50 employees.

The Aspirus/Arise plan will provide enrollees with discounted in-network rates at Apirus’ six hospitals and doctors employed by or who contract with the health system (Herman, Modern Healthcare, 10/16).

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