'Time's up': California exchange insurers to drop in-network hospitals missing safety marks

Covered California, the state's health insurance exchange established under the ACA, will require participating payers to kick hospitals who don't reach certain safety and quality measures out of their network, WBUR news reports.

Here are five things to know about the policy.

1. In less than two years, hospitals will lose in-network status with Covered California insurers if they don't cut back on unnecessary C-sections, prescribe fewer opioids, and perform fewer X-ray, MRI and CT scans to diagnose back pain.

2. The new policy poses significant consequences for California hospitals missing the target. 1.4 million Californians purchase their health insurance through the state exchange from 11 health insurers.

3. Lance Lang, MD, CMO of Covered California, told WBUR, "We're saying 'time's up.' We've told health plans that by the end of 2019, we want networks to only include hospitals that have achieved that target."

4. For C-section rates, Covered California is setting the target rate at 23.9 percent for low-risk births. Several California hospitals are delivering 40 percent of low-risk births by C-section, and at one hospital, the rate is 78 percent. Leah Binder, CEO of the Leapfrog Group, told WBUR Covered California's impending policy is "probably the boldest move we've seen in maternity care ever."

5. Most of California's 243 maternity hospitals are on board with the C-section goal, with 40 percent already meeting the target, according to the report. Health plans can also request exemption from Covered California's new rule, and keep noncompliant hospitals in network, if they document their reasoning.

More articles on payer issues:
Anthem to stay in Indianapolis, invest $20M in HQ
CBO: 3M fewer Americans will have insurance in 2019 after individual mandate ends
Anthem to acquire palliative care provider Aspire Health: 4 things to know

© Copyright ASC COMMUNICATIONS 2018. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.

 

Top 40 Articles from the Past 6 Months