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Will Physicians Be Dropped From Managed Care Networks?

Greg Freeman, January 22, 2014

Because of the consolidation, insurers are tending to contract with larger organizations such as accountable care organizations (ACO), large physician group practices, and hospitals that are increasingly hiring physicians, Laurence says. Working with larger providers allows more cost-effective contracting, she explains, especially with the focus on quality measures as the determinant of payment rates.

"Physicians can't bury their heads in the sand. They have to see what's going on in the marketplace and figure out how they are going to be clinically integrated," she says. "It is going to be very difficult to practice in the marketplace as a solo practitioner. That is not a realistic option anymore."

Even if you do not move to an ACO, larger group, or hospital employment, the rest of the healthcare industry will respond to that trend, Laurence says. Insurers will increasingly focus on quality measures even with those physicians who manage to stay in a small practice and retain network affiliations, she says.

"You're not going to be providing care the same way in the future. Physicians would be smart to start ­planning their future and determining how to be successful in this new healthcare environment," Laurence says. "It may be baby steps, but at least take some steps in that direction."

For instance, Laurence works with a solo practitioner who has been on his own for more than 20 years and does not want to join a hospital group or ACO. But he is hiring additional physicians and staff to create a small practice group that can more effectively generate the quality outcomes data that insurers are looking for now, Laurence says.

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4 comments on "Will Physicians Be Dropped From Managed Care Networks?"


F.H. Netter (2/17/2014 at 4:42 PM)
This is just one more reason the for-profit health insurance system must go. We need single payer and we need it yesterday.

Barbara Ryan (1/23/2014 at 8:09 PM)
Insurers only have to "rein in costs" in order to maintain (or grow) their profit margins. Insurers have been decreasing payments to providers while increasing charges to those they insure for a long time. Obamacare is only the tip of the iceberg of making medical care accessible and affordable[INVALID]insurance industry reform and regulation is also critical.

Doyle (1/23/2014 at 4:48 PM)
Looks like some high quality physicians will draw the higher income patients. Ones that can afford out of network fees. That would be different