Insurers Partner With Local Providers, Build Narrower Networks
Some large insurers in California are partnering with local health systems to offer plans through the state health insurance exchange that will cost less and have narrower provider networks, U-T San Diego reports.
However, observers say the partnerships could make it more difficult for consumers to find a plan that includes a certain provider.
Details of Partnerships
Some large health care providers -- such as Sharp HealthCare and Kaiser Permanente -- offer insurance plans through the exchange that include their own doctor networks.
However, other insurers are partnering with local providers to build such networks and keep costs down.
For example, for exchange plans offered in San Diego:
- Anthem Blue Cross has partnered with UC-San Diego; and
- Blue Shield of California has partnered with Scripps Health.
Both health systems agreed to take discounted reimbursements in order to participate in the exchange plans and draw more new patients, executives said.
Scripps CEO Chris Van Gorder said he would be "surprised if anybody didn't discount their rates" in order to be included in a provider network in the exchange.
"We assume we are going to get volume in return, but we didn't negotiate any guarantees," Van Gorder said, adding, "We just believed we had a community obligation to participate."
The partnerships will enable insurers to market health plans with narrower provider networks than policies they have offered in the past.
The deals enable lower costs for insurers and increased patient volumes for providers, but they also could make it more difficult for consumers to find a plan that includes their doctor.
According to U-T San Diego, the "big question" is whether the narrower networks will be able to handle the influx of new patients under the Affordable Care Act.
Patrick Johnston, president and CEO of the California Association of Health Plans, predicted that supporting the higher demand will not be a problem for providers.
"We expect that people are going to be very happy with the tailored networks set up in each region of California to provide care," Johnston said, adding, "Does that mean every doctor and hospital is included? No."
Some Providers Reject Exchange Networks
Meanwhile, Wayne Knight -- executive director of health care reform at Tri-City Medical Center -- said some smaller physician groups with full or near-full caseloads are not willing to accept discounted reimbursements to be included in an insurer's exchange network.
"A lot of physicians are saying, 'I'm not going to do it; it's just not worth it,'" Knight said (Sisson, U-T San Diego, 11/13).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.