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
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    stress management for healthcare workers
    3 Tips For Healthcare Professionals: How To Stay Beautiful, Healthy, and Happy
    November 2, 2021
    importance of relaxing on the weekend for your health
    Importance of Relaxing During the Weekend for Optimal Health
    March 25, 2022
    LASIK Eye Surgery
    What Is LASIK Eye Surgery?
    May 16, 2022
    Latest News
    6 Easy Healthcare Ways to Sit Less and Move More Every Day
    September 10, 2025
    7 Most Common Healthcare Accreditation Programs: Which Should You Use?
    August 20, 2025
    Hospital Pest Control and the Fight Against Superbugs
    August 20, 2025
    Hygiene Beyond The Clinic: Attention To Overlooked Non-Clinical Spaces
    August 13, 2025
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    Heroism in Harm’s Way
    February 21, 2015
    5 Things Every Trainee GP Should Know
    August 27, 2019
    Top 5 Facts About CPPA Accreditation
    April 9, 2015
    Latest News
    Healthcare at a Crossroads: Why Leadership Matters More Than Ever
    September 9, 2025
    How Social Security Disability Shapes Access to Care and Everyday Health
    August 22, 2025
    How a DUI Lawyer Can Help When Your Future Health Feels Uncertain
    August 22, 2025
    How One Fall Can Lead to a Long Road of Medical Complications
    August 22, 2025
  • 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

Is the GOP Ready to Get Serious About Medicare?
Healthcare Communication Industry Tests New Offerings as Health Care Reform Evolves
7 Best Blogs to Follow About Healthcare Legislation
Driving Down the Real Cost of Healthcare: Pediatric and Teen Medical Homes
Study: Medicaid Coverage ‘Substantially’ Improves Access to Care

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

a woman walking on the hallway
6 Easy Healthcare Ways to Sit Less and Move More Every Day
Health
September 9, 2025
Clinical Expertise
Healthcare at a Crossroads: Why Leadership Matters More Than Ever
Global Healthcare
September 9, 2025
travel nurse in north carolina
Balancing Speed and Scope: Choosing the Nursing Degree That Fits Your Goals
Nursing
September 1, 2025
intimacy
How to Keep Intimacy Comfortable as You Age
Relationship and Lifestyle Senior Care
September 1, 2025

You Might also Like

obamacare
BusinessHealth ReformPolicy & LawPublic Health

Repealing ObamaCare, Cutting Taxes and Gutting Social Programs Isn’t Pro-Growth

October 23, 2013
ACOs in 2014
BusinessHealth ReformPolicy & Law

Studies Show ACOs Are Succeeding in 2014

August 3, 2014
health-care-reform-overview
Health ReformMedical RecordsNewsPolicy & Law

Healthcare Reform’s Impact: Staff and Service Cuts Expected

December 15, 2011

Bundled Payments for Care Improvement Initiative Announced by CMS Center for Innovation

August 25, 2011
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?