Finding the right yardstick to rate a health plan’s provider network can be complicated.
The board of Connecticut’s state-based health insurance exchange, Access Health CT, talked about the challenges at a recent board meeting.
The U.S. Department of Health and Human Services is in charge of network adequacy at the Patient Protection and Affordable Care Act exchanges it runs.
It already encourages carriers to provider “substantially similar” networks on and off-the exchange. It recently responded to network adequacy complaints by proposing that exchange plans should cover 30 percent of “essential community providers” in 2015, up from 20 percent today.
Access Health CT staff members tried looking at their state’s private exchange plans using the “substantially similar” standard and the proposed “essential community provider” standard.
Anthem had the most providers overall. It already meets two of the community provider standards, is close to meeting a third, and has three times more providers than the QHP with the smallest network, but it came in last in terms of the network similarity standard.
Exchange managers said they will try to respond to concerns about network adequacy by requiring carriers to make good efforts to meet QHP network standards this year, and by setting a new “reasonable access” standard for 2015.
The 2015 standard could include member-to-provider ratios, geographic information, and provider type data, exchange managers say.
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