Narrow health provider networks existed before the ACA (think of Kaiser as the original narrow network) and can provide quality health care, UCLA Center for Health Policy Research Director Gerald Kominski writes today in a Center for Health Reporting column, but finding a way to measure, monitor and ensure adequacy of and access to health networks is critical.
Kominski also spoke on the topic during the Center’s October Health Policy seminar, and said some studies suggest narrow networks were equal to regular networks. Although there are some legitimate concerns over limited networks, Kominski said much of the concern is driven by politics — those opposing the Affordable Care Act. “We just don’t know how narrow networks were before the ACA — we weren’t tracking it.”
Focusing on whether an insurance plan’s provider network is adequate, whether care is accessible, and how well providers are performing, rather than whether the network is narrow, is more important when choosing an insurance plan, he said. The current “star” system used by Covered California to rank plans is a going in the right direction, but is too limited — health care has “probably 30 or 50 dimensions” that need to be measured – in areas such as primary care, specialty care, emergency services, inpatient hospital care, and more – that can’t be collapsed into a limited number of stars, Kominski said.
Understandable quality measurements need to be put “in the hands of consumers in a way that facilitates decision-making,” Kominski said, “And that’s where I think we have a lot of progress to make.”
Watch the seminar video.
The Affordable Care Act (ACA) has created a greater degree of standardization of health insurance plans than has ever existed in the individual (non-group) health insurance market. All policies are required to have Essential Health Benefits, as well as four metal tiers based on plan actuarial values and standard limits on maximum annual out-of-pocket spending. As a result, one of the most significant remaining features of health plans that can vary considerably is the number of doctors and hospitals contracting with each health plan.
The fact that many health insurers offered plans through ACA Exchanges in 2014 and 2015 with so-called “narrow networks” has led to some concern that those buying health insurance in the individual market, both inside and outside the Exchanges, now face more restricted access to doctors and hospitals in their immediate geographic area. Furthermore, this restricted access has raised concerns about possible adverse health consequences.
This October 28 seminar will present an overview of the impacts of “narrow networks.” In it, Gerald Kominski
, the Center’s
director, will summarize what is known about narrow networks from the research literature; discuss challenges in defining and measuring network adequacy; and propose further research to determine whether narrow networks are necessarily associated with lower quality care.
Join us in person or via live-streaming webinar here: http://connectpro72759986.adobeconnect.com/uclachprss2015/
What: “Narrow Networks: Do We Know When Networks Have Become Too Narrow?”
When: Wednesday, October 28, 2015
Time: Noon - 1.pm.
UCLA Center for Health Policy Research, 10960 Wilshire Blvd., Suite 1550, Los Angeles, Calif. 90024 [Map
Note: A light lunch will be served to in-person attendees, first-come, first-served.
It is with deep sorrow that the Center announces the passing of Dr. Gail G. Harrison, a faculty associate and distinguished food security scholar and advocate on behalf of at-risk populations, especially low-income women and children. Gail, a professor emeritus in the UCLA Fielding School of Public Health’s Department of Community Health Sciences, wrote numerous Center studies on the determinants, measurement, and functional consequences of nutrition, malnutrition, and food security.
She was recognized nationally for her work to improve the foods offered to families served by the Women, Infants and Children (WIC) program as well as her efforts to improve nutritional standards and menu planning for the National School Lunch Program and the School Breakfast Program. Beyond the United States, she consulted with the World Health Organization and UNICEF, and worked in Egypt, Sudan, Iran, Indonesia and Lesotho. In recent years, Gail helped to raise awareness about the effect of the Great Recession on family food security in a widely-read Center study.
“Gail believed that there was no good excuse for hunger and malnutrition, in this nation and throughout the world,” said Gerald Kominski, director of the UCLA Center for Health Policy Research. “She used her considerable expertise, as well as her compassion and warmth, to change lives for the better. She will be dearly missed.”
Read more tributes from California Food Policy Advocates, where Dr. Harrison served as a board member.
Data from new questions on health insurance from the 2013 and 2014 California Health Interview Survey (CHIS) are available in the California HealthCare Foundation’s ACA 411, the Web query tool that tracks changes in health coverage, access and affordability in California after health care reform. The numbers suggest improvements in access to care, including that the uninsured rate is at a new low and fewer Californians are delaying or skipping necessary medical care, according to the CHCF.
Among the key findings from the 2014 data:
- The number of Californians under 65 without insurance dropped 12%, falling from 16% of the population in 2013 to 14% in 2014.
- Uninsured rates declined notably among people living below 138% of FPG and among African Americans.
- The share of the California population ages 18 to 64 enrolled in Medi-Cal rose 52%.
- The proportion of uninsured Californians reporting cost as the reason for lacking coverage fell from 53% to 43%, though lack of affordability remains the most common reason cited for going without insurance.
The CHCF supported additional questions in CHIS to help monitor the implementation of health reform in California. Information from ACA 411 can be exported and shared, and new data will be added as they become available.
View the web tool here.