Modern Healthcare Looks to Joel Ario on Provider Network Size Requirement Split

Modern Healthcare Looks to Joel Ario on Provider Network Size Requirement Split

"Taking Stock of Exchanges"
Modern Healthcare

October 6, 2012 - Modern Healthcare turned to Joel Ario, a managing director with Manatt Health Solutions, for insight into why providers are split over the size of provider network designs.

As reported by Modern Healthcare, the degree to which states have moved toward creating the health insurance marketplaces under the ACA has varied widely, and many of their details remain unfinished. However, policy differences have emerged in the early-adopter states, which may preview provider battles nationwide as exchanges spread.

The law requires exchanges to offer coverage statewide but is silent on whether each plan within each exchange has to offer statewide coverage. Providers are pushing on the size of the provider networks each health marketplace must include. Industry experts told the publication that providers are split on network size requirements. For example, Colorado Community Health Network, which represents federally qualified health centers in the state, has taken no position, but its members in more expensive areas favor a statewide network requirement, while providers in other areas don't.

Ario said that the split among hospitals and other types of facilities over provider network designs has not always occurred in predictable ways in states developing exchanges. "What would be hard to say is that it's always the rural hospitals that worry and the urban hospitals that are happy or vice versa," he said. "It doesn't break down that way that I have seen; it depends on market conditions."

Among the few common concerns across states, Ario said, is that urban and wealthy hospitals are more worried that the exchange plans will cut into their revenue.





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