Health maintenance organizations and exclusive provider organizations are on the rise as insurers attempt to control costs and ACA exchange losses, The Wall Street Journal reports. HMOs and EPOs can narrow consumers’ provider network by requiring them to use one large hospital system and its affiliates. This cuts insurers’ expenses, as hospitals and specialists with high reimbursement rates are excluded.
As for broader network plans, next year about a quarter of ACA exchange plans in the 18 states will be preferred provider organizations, which allow consumers to visit physicians without referrals from primary care physicians. About 15 percent of consumers on the exchange will have no PPOs to choose from, while 82 percent will be able to choose between PPOs and HMOs/EPOs and 3 percent will only have PPO choices.
All insurer types included in the analysis are expected to increase HMO/EPO options next year. Narrow network plans represented 64 percent of offering in McKinsey’s sampled states this year, up from 55 percent in 2015.
More articles about payer issues:
BCBS of Georgia says it will be sole insurer on ACA exchange
Federal officials face adverse consumer, political response amid ACA marketplace changes
Study finds 1 in 5 Louisianans were uninsured pre-Medicaid expansion
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