Physician participation dips in marketplace plans, SERMO says

Dive Brief:

  • Doctors who say they will be participating in health plans offered on the Affordable Care Act marketplaces have dropped 4% this year, according to a new poll of 1,682 physicians conducted by SERMO, a physician social media network.
  • While 61% of physicians expected to participate prior to open enrollment for 2016, the number is down to 57% as we head in to open enrollment for 2017.
  • The modest 4% change may be taken with a grain of salt given that the poll has an error of plus or minus three percentage points.

Dive Insight:

Some level of difference seems a given considering that insurer marketplace participation is significantly down going into next year. Following scale-backs by players including Aetna, Humana, and UnitedHealth, as well as additional co-op failures this year, a minimum of 1.4 million people are expected to see their current ACA health plans disappear from the marketplaces.

The bigger surprise might be that the difference in physician participation doesn't appear to be higher, suggesting that many physicians are (or were) participating in Obamacare plans via more than one network, and that participation may still be high partly due to the significant and continued presence of Blue Cross and Blue Shield plans, noted Forbes.

Many physicians, practices and hospitals are likely aiming for stability in their network/exchange participation, SERMO noted, despite fluctuation around the attached plan offerings, in an attempt to minimize the need for patient turnover.

Numerous hospital systems have indicated they expect to see adequate or increased business from ACA networks in which they participate and that will still exist on the exchanges next year, Forbes added.

Filed Under: Payer
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