Breadth of provider networks vary by plan
June 29, 2015
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June 29, 2015
A study recently came out indicating that provider coverage for an insurance plan (roughly understood as the number of providers that accept a specific insurance plan) can vary greatly among insurance plans. This can have very practical implications when issues arise (e.g. if someone needs to see a specialist and realizes that the desired specialist is not considered in-network). The health insurance exchanges have generally done a pretty good job of helping consumers compare plans on the financial dimensions (e.g. premium, maximum out-of-pocket); they have generally done a pretty lousy job of comparing strength of provider networks (at most, many exchanges offer a doctor directory that allows consumers to check for network status for specific doctors).
As more and more consumers become surprised by who is in-network and who is not, consumers are likely to push for metrics to help compare provider networks across insurance plans. Over time, I expect that tools to compare the non-financial dimensions of insurance plans will become more and more sophisticated.
June 19, 2015
The California State Auditor issued a report faulting the state of California for not verifying network information provided by health insurance companies. Part of the state's regulatory function is to help ensure that health insurance plans have a wide enough network of doctors that plan participants can get sufficient care. The report highlights some dysfunctions of the state government (including an antiquated computer system at the ombudsman's office that "crashes" under the load of incoming complaints), but what is particularly interesting to me about the report is how some provider directories are riddled with errors, even though they were provided by insurance companies.
The auditor sampled three provider directories in three different counties, and found that one directory had inaccuracies in 23% of the profiles that they verified. Ironically, the error rate seems to correlate with the size of the insurance company. The smallest insurance company that was sampled was noted as sending out people to each doctor's office between eight and ten times a year to verify information.
Provider directories seemed to have been an area of neglect on the part of many insurance companies for a long time. The federal government is considering changes that will require insurances companies to update their directories more frequently. It seems it would behoove insurance companies to band together to form a service that offers doctors an easy-to-use centralized interface to update contact information, as well as plan acceptance status.
June 13, 2015
In what may denote a capitulation to broader trends of the time, the American Medical Association (AMA) has publicly encouraged physicians to engage with the transparency efforts that are growing stronger and stronger within the industry. The AMA is noted for its decades-long vehement opposition to the disclosure of Medicare claims data in the interest of privacy.
It's certainly difficult for any organization to call for less transparency in health care (how much less can there be?). What remains to be seen is whether AMA will actually engage and actively help develop metrics that can be deployed, or whether they are simply providing lip service. Given the longstanding interest in clinical outcomes (e.g. National Quality Forum was established in 1999), I suspect that developing the technical metrics for measuring quality is difficult, but that difficulty pales in comparison to the social challenge of getting the metrics adopted. Nevertheless, that the AMA has publicly proclaimed support for improved transparency is a meaningful and positive step.
June 06, 2015
As another sign of a changing industry, The Washington Post published an article about hospitals increasingly monitoring their online reviews. Formerly scorned or ignored, online reviews have increasingly garnered attention from some providers, either because they are seen as a source of feedback or more likely, because they affect providers' bottom lines.
Online reviews used to be widely dismissed by the medical community (and in some cases suppressed). Then, some business-savvy providers started paying attention to them, and then even more providers started cultivating their online reputations. Now, some healthcare systems even dedicate an entire person's time to managing such reputations. We currently see a dearth of medical quality information about providers; perhaps that will trend in a similar fashion over time.
May 29, 2015
Some states are seeing insurers asking for large hikes in their premiums, some as large as 50%. Some say that part of the large changes are because insurers are only now able to accurately price their policies, given how recently the statewide individual exchanges have rolled out.
Clearly, these changes are not great for consumers in the short run. I suspect that as premiums continue to rise, though, more and more people will consider the lower-tier plans (e.g. bronze) and will wrestle with the question of whether the higher premiums are worth the lower deductibles. In turn, as more and more people are exposed to the state of pricing in health care, there will first be more pressure to be able to find out prices easily, and then more attention on why health care costs as much as it does.