This is a guest post from Tom Barrett of BBG, a highly-regarded employee benefits consulting firm with deep expertise in flexible spending programs and medical management.
The title above plays off of an old adage wisely employed by a very sharp and highly respected colleague.
Here’s one take on narrow provider networks as seen from the trenches. While it’s mostly informal and unscientific it is cast with an experienced eye when it comes to networks:
Many of the narrow networks offered prior to 2014 placed a more discerning emphasis on contracting with higher performing providers. We think these networks at least leaned more toward striking the combination of higher quality and lower cost.
Some (“some” emphasized) of the new narrow networks, especially those created primarily for the exchanges, appear almost exclusively aimed at low cost. In fact, during the run-up to 2014 some carriers indicated that on the exchanges especially, low cost would win. Period. They indicated that network contracts comprised of low fee schedules was the way to get there. New networks were developed with the key goal of being on the “first page” (lowest cost, think airfare searches, rental cars, hotels, etc.,) when plans were shopped.
Describing how carriers built these new networks, one highly respected industry insider indicated that contracts containing these low fee-schedules were mailed out to the provider community. Carriers then waited to see which of the providers would accept the low fee schedules and sign-up. The new networks were then built accordingly.
Probably not surprisingly, some of these new narrow nets bear a striking resemblance to Medicaid networks and are comprised mainly of providers willing to accept Medicaid-like fee-schedules. We think that it’s safe to say that the quality and outcome side of the equation did not rule the day in the development of these networks.
So what’s the “net” for all of us?
Caveat emptor. We’re not suggesting it’s necessary or even wise to shy away from all the narrow nets.
Rather, make darn sure you do your homework before building or selecting a plan that’s associated with one.
We don’t expect this to go away and expect provider and network evaluation to continue to grow in importance for everyone going forward, most especially for individuals and small and mid-size businesses ……….