THE BLOG
08/19/2014 01:56 pm ET Updated Oct 19, 2014

Let's Put Some Muscle on Those Skinny Health Care Networks

Have you heard about the latest fad in health care? It's called "skinny networks."

Normally, when I hear the words "skinny" and "health" in the same sentence, I think about the importance of diet and exercise. Yet, when we're discussing health provider networks, there's nothing healthy about skinny.

A health provider network is the set of primary care doctors, specialists, hospitals, and other facilities in a patient's health plan. When you're selecting your health insurance, often one of the first things you do is check the provider list on the insurer's website. You want to know whether you'll be able to see your doctor if you choose that plan.

However, being able to see your family doctor isn't the only thing that matters in a health provider network. Patients also count on networks to offer specialists and facilities close to home, so they can get care they need when they need it, without exorbitant out-of-network costs.

This is what makes the emergence of "skinny networks" so troubling. These skinny networks include a very limited list of providers and health care facilities, in the name of lower costs. Insurers have begun unveiling them along with implementation of their coverage under the Affordable Care Act (ACA), the federal health reform.

The ACA is doing a tremendous amount of good, getting insurance to millions of people who otherwise would be uninsured, and lowering costs for many more -- but the use of these skinny networks threatens to undermine all the progress we've made if it's left unchecked.

Here are some of the biggest problems that skinny networks can cause -- problems that are already affecting many patients:

• Your personal providers aren't included in your plan. In some cases, doctors appear on provider lists even when they aren't in the network. California's Director of Managed Care is investigating insurers for bait-and-switch tactics.

• The listed providers aren't taking new patients.

• Key medical facilities are missing from health plan in some states. In Washington state, Children's Hospital is left off many insurer's lists, even though it's the state's largest and most prestigious pediatric facility.

• Providers and facilities are too far from home. Excessive travel times leave patients no choice but to go out-of-network for care -- or go without care altogether.

• Patients receive unexpected bills when doctor offices don't inform patients they are out of their network.

• Patients aren't getting health care their own language. Interpretation and translation services help assure that patients' medical needs are met.

The good news is that we can eliminate skinny networks -- the ACA itself provides the tools for doing so. For starters, the law requires "network adequacy" for all plans sold through health reform exchanges. More specifically, ACA exchange health plans must guarantee "all services will be accessible without reasonable delay."

Both federal and state regulators have a role in making sure that insurers are meeting these requirements. State regulators can build on the baseline federal requirements to tailor network guidelines for their populations and geographies.

Here are four approaches policymakers can use to solve the skinny network problem:

• Apply Medicare standards to health plans in the health reform exchanges. Medicare requires health plans to have a primary care provider within 15 miles or 30 minutes of a given patient.

• Create a stronger review process for exchange plans. Both state and federal regulators should evaluate health plans for network adequacy before those plans hit the market.

• Establish ongoing oversight of plans. Provider networks can change -- so regulators need to keep an eye on them for continuous adequacy. Regulators should aggressively investigate any kind of bait-and-switch tactics.

• Provide interpretation and translation services. Make language services an integral part of coverage -- and pay for it accordingly. Insurance companies need to build diverse networks that respond to the language needs of their clients.

The next open enrollment period for health exchange coverage is coming up in the fall. Insurers are submitting their plans for approval now -- making this an ideal time to apply effective oversight.

Let's put the meat back on the bones of these skinny networks. That will make us -- and our entire health care system -- much more fit and robust.

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