With all the emphasis on quality, some of the physician terminations may be surprising because the insurers are not just dropping poor performers, Osowski notes. At the same time they are looking for quality, they are looking for cost savings, and sometimes those goals can compete. The result sometimes is that the networks will drop physicians or groups that are providing high-quality care because that care skews too heavily in the expense consideration, he explains.
In addition, the insurance industry and consumers are not as focused on broad networks as they have been in the past.
"Now there is a feeling on the part of the plans that the appeal of the broad network is no longer as important a factor when they are trying to put together a network that provides reasonable access and availability but at the same time keeps costs down," Osowski says. "Not all plans are adopting the narrow network strategy, but their costs tend to be higher if they don't. It remains to be seen if the narrow strategy will even work, and a lot of that depends on the profile of the people who come into the exchanges and buy insurance. Are they going to select plans based on price or whether their physicians take part in the program?"