Employers are increasingly willing narrow their networks of hospitals and physicians in return for lower premiums, according to report by American Medical News.
Large insurers such as Aetna, CIGNA, Health Net, UnitedHealth Group and BlueCross BlueShield-affiliated plans like WellPoint have pointed to customers' growing interest in narrow networks. "Employers are willing to limit choice to create a better cost advantage," even if it may mean forcing employees to change physicians, said Joe Zubretsky, chief financial officer of Aetna.
In contrast to tiered networks, which put some providers into lower tiers and force patients to pay higher out-of-pocket charges for them, narrow networks remove providers from the network and do not cover any charges from them.
Both narrow and tiered networks rate hospitals and physicians based on quality and efficiency, but even some proponents admit measurements are not accurate and precise. The AMA has accused tiering systems of being rife with inaccuracies, which insurers dispute.
After New York Attorney General Andrew Cuomo charged many large insurers with creating tiered or narrow networks based on cost while marketing them as quality-based, the insurers signed a legal settlement. They agreed not to base ratings solely on cost and to disclose their methodology. However, health plans now say they can measure quality well enough to offer narrow networks based on both cost and quality.
Read the American Medical News report on health insurance.
Read more coverage on health insurance networks:
- RAND Corp. Study Finds Insurers' Efforts to Send Patients to Lower-Cost Physicians Misleading
- Out-of-Network Payment Squeeze: 4 ASC Trends and Challenges
- Hospital Strategies and Transactions: Healthcare Reform and Market Evolution
Large insurers such as Aetna, CIGNA, Health Net, UnitedHealth Group and BlueCross BlueShield-affiliated plans like WellPoint have pointed to customers' growing interest in narrow networks. "Employers are willing to limit choice to create a better cost advantage," even if it may mean forcing employees to change physicians, said Joe Zubretsky, chief financial officer of Aetna.
In contrast to tiered networks, which put some providers into lower tiers and force patients to pay higher out-of-pocket charges for them, narrow networks remove providers from the network and do not cover any charges from them.
Both narrow and tiered networks rate hospitals and physicians based on quality and efficiency, but even some proponents admit measurements are not accurate and precise. The AMA has accused tiering systems of being rife with inaccuracies, which insurers dispute.
After New York Attorney General Andrew Cuomo charged many large insurers with creating tiered or narrow networks based on cost while marketing them as quality-based, the insurers signed a legal settlement. They agreed not to base ratings solely on cost and to disclose their methodology. However, health plans now say they can measure quality well enough to offer narrow networks based on both cost and quality.
Read the American Medical News report on health insurance.
Read more coverage on health insurance networks:
- RAND Corp. Study Finds Insurers' Efforts to Send Patients to Lower-Cost Physicians Misleading
- Out-of-Network Payment Squeeze: 4 ASC Trends and Challenges
- Hospital Strategies and Transactions: Healthcare Reform and Market Evolution