The Narrow Network Myth

Written By: Dr. Safa Farzin CEO, Medical Group of Pennsylvania

Pennsylvania’s Affordable Care Act (ACA) marketplace consumers are poised to experience a 30% increase in premiums in 2018. Even prior to the cancellation of insurance company subsidies, an 8% increase was planned. Healthcare costs continue to increase and large hospital systems and insurance companies continue to tout narrow networks to individuals and small businesses as a cure for the increase in healthcare premiums.

A narrow network health plan selects where a patient can seek healthcare. The plan either does not include certain physicians and facilities or it charges an increased out of pocket fee if the patient decides to use a “second tier” or “out of network” provider or facility. Generally, information regarding the list of included narrow network providers is very challenging to track. Changes in the makeup of the network over the course of the year is even more difficult to assess. The result is a poorly defined network that can disappoint patients as they seek care after purchasing a health plan.

The Medical Group of Pennsylvania (MGP) represents 75 independent physician practices and more than 350 physicians throughout Central PA. These practices have thrived during difficult times in healthcare and have thousands of strong patient doctor relationships. After open enrollment, frustrated patients frequently call our home office explaining that their new insurance plan excludes their longtime physician or that they cannot afford the new $90 copay that has been added to their once routine visit. Physicians in our association express equal concern that without notice or reason they have been deemed out of network with a plan they have serviced for years.

If networks are supposedly narrowed for cost and quality purposes and most of the health plans in the ACA exchange are narrowed, why then do health insurance costs continue to increase? Excluding independent physicians from narrow networks is a pivotal mistake. Independent physician practices are typically more cost effective than other providers for several reasons. Patients who utilize hospital facilities are frequently charged facility fees. These fees add no value to the service and are not charged by independent physicians. Additionally, the Journal of the American Medical Association found independent physicians to be more cost effective than their employed counterparts by greater than 40% (JAMA Oct’14). Quality is of prime importance as well. Independent physicians prior to and after MGP’s formation have focused on quality in their own offices as well as their local hospitals. MGP has recently partnered with Highmark Blue Shield to continue our focus on care coordination, disease prevention and cost awareness. Highmark Blue Shield’s data analytic capabilities have greatly advanced MGP’s mission of cost effective quality care.

As you begin open enrollment, be mindful of the limitations of the network you choose. Ask your health insurance broker if your trusted physicians are in network. The independent physicians of the Medical Group of Pennsylvania are a proven high-quality cost-effective entity in Central PA. To ensure we are in your network or for more information about independent physicians in your area visit MedGroupPA.com.