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Prescription for Narrow Networks: Add Transparency

Christopher Cheney, for HealthLeaders Media, June 4, 2014

Removing the consumer pinch from narrow provider networks in individual insurance exchanges is a matter of striking a "delicate balance" between payers and the insured, suggests a Robert Wood Johnson Foundation report.

One of the main levers insurers have to keep premiums affordable in the individual health insurance exchange market—a narrow provider network—is a double-edged sword.

On one edge, crafting a selective network of healthcare providers based on their ability to deliver high-quality services at the lowest possible cost has helped insurers offer affordable HIX policies to consumers.

On the other, narrow networks can be disruptive and inconvenient for consumers, requiring them to switch doctors and drive long distances to receive in-network services that are not provided near their homes. This is not only an inconvenience for patients, but can be a barrier to treatment.

It's up to regulators to "strike a delicate balance" between insurers and their 8 million new customers in the individual exchanges spawned by the federal Patient Protection and Affordable Care Act, according to a Robert Wood Johnson Foundation report released last week.

The potential for a consumer backlash is being expressed in New Hampshire, which is a uniquely stark case study on the impact of narrow networks. Anthem Blue Cross Blue Shield is the only commercial insurer operating on The Granite State's new health insurance exchange, and the carrier excluded 10 of the 26 NH acute care hospitals from its HIX provider network.

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