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Network Adequacy: Seeking Balance

Alliance for Health Policy

Sept. 26, 2014
Recorded Online

[Recorded online]

Some new health plans sold in the insurance marketplaces are offering consumers networks that exclude certain doctors, hospitals and other medical providers. While some claim that these networks hamper provider access and choice, others contend that this approach, if done the right way, helps consumers by creating competition and controlling costs.

The federal and state governments are now considering how to best regulate provider networks. The National Association of Insurance Commissioners (NAIC) is finalizing its update of model regulations for states, while the Department of Health and Human Services (HHS) is deciding what federal role, if any, it will assume. HHS already regulates networks for Medicare Advantage health plans, and some say this could serve as a model for health plans sold in marketplaces.

Speakers include:

  • Mike Leavitt, founder and chairman, Leavitt Partners, former Utah governor and HHS Secretary under George W. Bush, will address the issues surrounding network adequacy, and his preference to regulate networks at the state level.
  • Stephanie Mohl, senior government relations advisor, department of advocacy, American Heart Association, will talk about research that assesses networks in a handful of states, and about challenges in making sure patients have access to specialty care.
  • Jolie Matthews, senior health and life policy counsel, NAIC, will discuss model network regulations that the NAIC may release in November. She will also talk about how insurance commissioners are handling the issue across the country.
  • Gretchen Jacobson, associate director, Kaiser Family Foundationís Program on Medicare Policy, will describe the current network adequacy standards for the Medicare Advantage program, which some see as a model for marketplace plans.
Two additional experts will join in the Q&A:
  • Steven Shapiro, executive vice president, chief medical and scientific officer, president of the physician services division, University of Pittsburgh Medical Center
  • Marc Barclay, vice president of provider networks and contracting, BlueCross BlueShield of Tennessee
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