Dive Brief:
- America's Health Insurance Plans (AHIP) is promoting a July 2 report from actuarial firm Milliman, Inc. finding that restricted or narrow preferred provider networks work well, delivering high-quality, efficient care at a better price without hurting access.
- According to Milliman, "high-value provider networks allow for more affordable coverage options with 5% to 20% lower premiums compared to broader network plans, while placing an emphasis on quality care," AHIP said.
- Insurers are offering narrower, more restricted provider networks on exchanges as a way to manage previously uninsured new enrollees, and off exchanges as a lower-cost option to attract cost-conscious individuals and groups.
Dive Insight:
AHIP said "high-value" provider networks should be one option across a variety of consumer options.
When limited/narrow- and tiered-network products proliferated last fall, some carriers offered one-health-system networks in certain markets. They and other insurers have been marketing limited networks as a way to save money while retaining quality care. At the same time, some single-site employers have gotten customized networks basically limited to one health system and associated physicians. And some hospitals and health systems are setting up super-narrow networks for their own workers, using the experience to convince payers to sign accountable care organization (ACO) contracts with them.
According to industry experts, this array of narrow-network plans is quite different from what was seen previously. The obvious reason to form narrow networks is to save on costs. If many people are channeled to a few select providers, they generally give better discounts. And many provider-owned plans want to direct care to their own facilities, so they go narrow to keep everybody in-network, which allows clinically integrated care and electronic health records and all kinds of things to save some money and improve care.
But how narrow is too narrow? As one industry expert said last fall: Choice could become so limited that in fact there is no choice.