The New Hampshire Insurance Department is moving forward with changing its rules for health care provider networks, but some insurance companies aren’t yet sold on a key part of the proposed approach.
Department officials say the rules are ripe for revision given how much health care has changed since the standards for evaluating network adequacy were enacted in 2001. They created a working group to begin the process last year, with a goal of having new standards in place in 2017.
Under the developing framework, the requirements would focus on making sure consumers have adequate access to different types of services rather than providers in order to better reflect changes in health care delivery. For example, nurse practitioners, besides doctors, also provide primary care.
Consumers would be guaranteed adequate access to “core services” such as primary care, pediatrics, urgent care, mental health care and substance abuse treatment within their community. Access to “common services” such as radiation oncology would be available within a community or in an adjacent community, while more specialized services would be available somewhere in the state or within New England.
At a meeting of the working group on July 10, several insurance company officials said they’re skeptical about the department’s plan to use hospital service areas to define the communities, and questioned whether changes in health care delivery could be taken into account without completely overhauling the standards.
“I’m not so sure we’ve bought into the change, and until we have, it’s hard to take assignments and work toward it,” said Paula Rogers of Anthem Blue Cross and Blue Shield of New Hampshire.
“The question was asked, what were the deficiencies in the present system that need to be addressed?” she said. “It hasn’t actually been answered.”
Tyler Brannen, health policy analyst with the insurance department, said the main deficiency was the high cost of health insurance. While acknowledging that other factors contribute, he said the network rules “absolutely” are tied to cost, and that updating them will spur competition among insurers and health care providers.
“If we can improve competition, while allowing for the same consumer protection, we at least have the potential to have lower costs or lower cost increases,” he said.
The state’s network adequacy standards have been in the spotlight since the Insurance Department approved Anthem’s network for individual health plans sold through the federal health care overhaul law in 2013 because several hospitals were not included. Those concerns have eased as more companies have begun offering plans through the online marketplace created by the law.
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