By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: Narrow Networks in California?
Share
Notification Show More
Font ResizerAa
Health Works CollectiveHealth Works Collective
Font ResizerAa
Search
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Policy & Law > Health Reform > Narrow Networks in California?
Health Reform

Narrow Networks in California?

David Harlow
David Harlow
Share
4 Min Read
narrow-road-ahead-sign
SHARE
narrow-road-ahead-sign

In the nothing new under the sun department, Covered California, the California health insurance exchange is “threatening to cut hospitals from its networks for poor performa

narrow-road-ahead-sign

In the nothing new under the sun department, Covered California, the California health insurance exchange is “threatening to cut hospitals from its networks for poor performance or high costs.” Kaiser Health News reports that Covered California’s board will vote next month on proposed policies designed to “chang[e] the underlying delivery system to make it more cost effective and higher quality.” If approved, hospital cost and quality outliers would be identified by payors and potentially excluded from exchange plans starting in 2018; physician reviews would be phased in later.

The news report describes this proposal as “novel,” “the first proposal of its kind in the country.” It maybe the first such proposal put forth by a health insurance exchange established under the ACA, but it is hardly novel. It goes to the heart of the deep American ambivalence about health reform. The American public wants “gummint outta my Medicare” but also wants government to protect healthcare as a right. The public wants unfettered access to health care resources but also wants to pay less. We know that we pay more than any other country for health care and don’t have much to show for it in terms of things like life expectancy and health status.

The proposal, at least in its broad outlines, applied rationally, makes perfect sense, and HMOs and other third party payors have been doing this for years: cost and quality control at the system level depends in large part on building narrow networks where provider participation is predicated largely on compliance with cost and quality requirements. (Put another way, there is a system of rewards and penalties in health care finance which is the new normal: value-based payment. The federales are pushing this idea — and say they’re hitting their goals — but, as may be said about most things in health care, per Gibson, the future is already here, it’s just not evenly distributed.) The failure to mandate narrow networks as part of the MSSP/ACO provisions in the ACA may have had good intentions behind it but is, to my mind, one of its key failings. (Technically, narrow networks are mandated, but member use of the networks is not.)

More Read

health_collective_ACA
Actuarial Study Results a Mixed Bag on Costs of Claims under ACA
Delay of Care of Adults Closely Tied to Tighter Medicaid Eligibility Rules
Avoidable ER Visits: Lessons from the Robert Wood Johnson Foundation
5 Aspects of CMS’s 2015 Proposed IPPS Regulations
Texas Lawmakers Revisit Medicaid/Medicare Secession Scenario with Bill’s Intro

So without some sort of narrow network controls it seems unlikely that all this can work, right? How can we expect unfettered access to all providers (well, the good providers that we want to go to) to yield cost savings and quality improvements? Holding into that expectation may perhaps be described as a health care manifestation of the Lake Wobegone Effect.

Welcome to California, where everyone is above average.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

You should follow me on Twitter: @healthblawg
             

Related Stories

  • Nick Marko and Geisinger’s Health Data Journey
  • Nick Marko and Geisinger’s Health Data Journey – Enclosure
  • Physician-Patient Collaboration: A Conversation With Dr. Danny Sands

 

Share This Article
Facebook Copy Link Print
Share
By David Harlow
Follow:
DAVID HARLOW is Principal of The Harlow Group LLC, a health care law and consulting firm based in the Hub of the Universe, Boston, MA. His thirty years’ experience in the public and private sectors affords him a unique perspective on legal, policy and business issues facing the health care community. David is adept at assisting clients in developing new paradigms for their business organizations, relationships and processes so as to maximize the realization of organizational goals in a highly regulated environment, in realms ranging from health data privacy and security to digital health strategy to physician-hospital relationships to the avoidance of fraud and abuse. He's been called "an expert on HIPAA and other health-related law issues [who] knows more than virtually anyone on those topics.” (Forbes.com.) His award-winning blog, HealthBlawg, is highly regarded in both the legal and health policy blogging worlds. David is a charter member of the external Advisory Board of the Mayo Clinic Social Media Network and has served as the Public Policy Chair of the Society for Participatory Medicine, on the Health Law Section Council of the Massachusetts Bar Association and on the Advisory Board of FierceHealthIT. He speaks regularly before health care and legal industry groups on business, policy and legal matters. You should follow him on Twitter.

Stay Connected

1.5kFollowersLike
4.5kFollowersFollow
2.8kFollowersPin
136kSubscribersSubscribe

Latest News

Epidemiological Health Benefits
Personal and Epidemiological Health Benefits of Blood Pressure Management
Health
October 13, 2025
Traumatic Brain Injuries
Understanding Traumatic Brain Injuries: What Families Need to Know
Policy & Law
October 10, 2025
Remote Monitoring touchpoints
Remote Monitoring Touchpoints Patients Will Actually Follow
Technology
October 9, 2025
dental care
Importance of Good Dental Care for Health and Confidence
Dental health Specialties
October 2, 2025

You Might also Like

Health Reform

Medical Malpractice Reform Losing Physician Support

November 7, 2011

Hospitals Push Hard for Medicaid Expansion

May 2, 2013
Global HealthcareHealth careHealth ReformHospital AdministrationMedical EducationMedical EthicsMedical RecordsNewsPolicy & LawPublic HealthUncategorized

8 Of The Most Bizarre Medical Malpractice Cases Out There

December 11, 2018
predictive modeling in healthcare
Health ReformHospital AdministrationMedical RecordsPolicy & Law

How Predictive Modeling Can Save Healthcare

July 27, 2013
Subscribe
Subscribe to our newsletter to get our newest articles instantly!
Follow US
© 2008-2025 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Username or Email Address
Password

Lost your password?