"The concept is to funnel a larger volume of patients to fewer, quality-selected providers, sometimes in exchange for lower reimbursement rates." - A quote from a recent Modern Healthcare article regarding a major, yet poorly-publicized access-to-care issue, discussing how "insurers [are] offering health plans on the public exchanges that feature narrow provider networks."
The true reason for the narrowing of provider networks is that hospitals are vying for position at the reimbursement table, cutting off providers that they deem out of network, typically solely because those providers are not currently employed by said hospital. This issue threatens to become a major political battle between hospitals and providers.
Patients are rapidly losing choices and reasonable access to care as the insurance networks become squeezed by what could be seen as collusion between hospitals and insurance companies. Pay attention people. Please be aware. The doctors that are in your network are not necessarily there because of "quality."
Case in point - until recently, there is one established neurointerventionalist in my town, Dr M. He is a doctor who treats brain aneurysms. It is a highly specialized field and he has been treating people for around 15 years with very good results. Recently, I received a request from a patient asking me if there are any other doctors in town who do what he does. Not being aware of any, I told her so and asked her what was the reason she doesn't go see Dr M? Her response - he's no longer in her network.
The same week, another patient asked me if there was a vascular surgeon in town who treats a certain kind of vascular problem. Not all vascular surgeons treat all ailments and this problem was more specialized than usual. I know of two of the six vascular surgeons in town who could help - both of them are "out of network" for this patient.
As these networks are squeezed by hospitals and insurers, access to care is being detrimentally affected. It is a subtle, insidious change that flies well under the radar of the well-publicized health care changes we are seeing in the media. The healthcare.gov website debacle is but one tiny facet of the overall changing face of healthcare.
Stay informed. Be aware.