New Report Outlines Ways to Strengthen Consumer Access to Provider Networks in New York State

NEW YORK, NEW YORK May 23, 2017—With health insurance premiums rising, delivery system reforms reshaping how services are provided, and the future of the Affordable Care Act in doubt, a United Hospital Fund report released today outlines ways to help consumers choose and use provider networks, and access timely care through stronger safeguards and improved disclosure.

The report, Networks at the Nexus: Revisiting New York State's Provider Network Standards and Protections, is based on analysis of health plan regulatory filings, actions in other states, and a roundtable discussion with consumers, health plans, and State policymakers convened by UHF.

Hundreds of thousands more New Yorkers have joined insurance plans since the Affordable Care Act went into effect four years ago, and health plans are increasingly trying to control costs by offering narrow networks of health care providers. A national survey released last October by the Kaiser Family Foundation found that Americans place access to sufficient networks of providers and hospitals as their second-highest health care priority after the cost of drugs. Networks at the Nexus examines consumer protections and network adequacy standards in New York and recommends a series of steps the State could take to ensure transparency and access on this issue of critical importance to health insurance consumers.

“State regulators face a delicate balancing act in seeking to maintain affordability, promote competition, and ensure access to needed care,” said Peter Newell, director of the UHF Health Insurance Project and author of the report. “By leveraging tools now available through a new provider network data system and fine-tuning existing network standards and consumer protections, New York has some solid opportunities to improve the accuracy and value of network information available to consumers, and to enhance access to care when network problems arise.”

Recommendations from the report include:

  • Creating a central database that records deaths, retirements, and changes in practice among providers, so health plans and regulators can improve the accuracy of provider directories;
  • Extending Medicaid Managed Care standards on waiting times for appointments to enrollees in commercial plans;
  • Improving New York's appeals process for consumers who want to see out-of-network providers;
  • Enhancing disclosure so consumers know when a provider participates in a plan but does not accept new patients, or when a health plan permits out-of-network access;
  • Updating 20-year-old standards that give consumers with serious illnesses continued access to their doctors when networks change;
  • Supplementing new “provider look-up” tools for consumers with data that allow them to better compare their options; and
  • Regularly convening providers, consumers, health plans, and policymakers to address issues with New York's standards, including the shortage of providers in rural areas.

“Amid the critical and ongoing effort to sustain gains made through the Affordable Care Act, it is important to keep two things in mind,” said UHF President James R. Tallon, Jr. “First, no matter what happens in Washington, New York policymakers are likely to retain control over the complex task of regulating provider networks. Second, the breadth and quality of the provider networks available to consumers are fundamentally tied to the value they see in purchasing and maintaining coverage.”

Networks at the Nexus: Revisiting New York State's Provider Network Standards and Protections was supported by a grant from the New York Community Trust. The full report is available for download from UHF's website.

About United Hospital Fund

United Hospital Fund works to build a more effective health care system for every New Yorker. An independent, nonprofit organization, we analyze public policy to inform decision-makers, find common ground among diverse stakeholders, and develop and support innovative programs that improve the quality, accessibility, affordability, and experience of patient care. For more on our initiatives and programs please visit our website and follow us on Twitter.

May 23, 2017
Focus Area
Coverage and Access
Health Insurance Project