Narrow Networks, and the Real Issue of Timely Access…

A front-page article in the Los Angeles Times is highly misleading about the health plans offered in Covered California, confusing several issues, ignoring existing issues and existing law, misdiagnosing the problem and the solution for consumers.

It ominously starts by suggesting “consumers could see long wait times, a scarcity of specialists and loss of a longtime doctor.”

The ability to see a doctor, and get a timely appointment, has been an ongoing issue and a top focus for Health Access for decades–we believe delayed care is denied care, and the lack of ability to get a timely appointment has significant impacts–from health outcomes to emergency room overcrowding. In fact, Health Access sponsored a 2002 bill to get state regulators to set clear standards for timely access to care, and then a decade-long effort to get that law properly implemented at the Department of Managed Health Care. It has started to be enforced with more vigilance–one health plan just got a $4 million fine on the issue. But the article never mentions that this has been an issue prior to Covered California, or about the existing consumer protection that Californians have.

The issue of timely access and network adequacy is distinct from that of narrow networks, or the number of doctors in a given network. From a consumers’ perspective, it doesn’t matter if the network is narrow if the consumer can get the doctors they want and need, and get an appointment in a timely fashion.

After that, it doesn’t matter if there are 1,000 or 10,000 doctors in the network. And such statistics are highly misleading, since some of those doctors may not be seeing new patients, may be doubled-booked with other health plans, and may not be in the areas of interest for the clientele.

So Covered California is actually a help, not a hindrance, to the effort of getting patients access to the doctor they want. When selecting a plan, there will be a tool where people can search and see exactly what providers are in which plans. So those with “narrow networks” are potentially at a disadvantage in that regard. But even with narrow networks, virtually all hospital systems are included in at least one plan in each region.

Covered California could do more. Right now it relies on existing state law–like the 2002 timely access statute and the current regulators to enforce timely access standards. It could raise the bar–as we recommended earlier in the year–by setting a standard for all plans, regardless of their regulator, in terms of timely access. The Department of Managed Health Care standard of two weeks for an appointment would be a good place to start, since most of their plans already have to meet that standard by law.

But what Covered California should not do is to back off on driving a hard bargain with insurers or providers–consumers benefit when Covered California uses its market power to weed out providers that provide low quality care at a high cost. Regular patients don’t have the information or wherewithal to make such distinctions, but that’s what a large, active purchaser can do.

So that’s what frustrating about the article: it focuses on the narrowness of the network, while missing the main issue of network adequacy and timely access, which is what consumers care about. And because of this, it points to this ongoing issue as a new problem created by Covered California, when in fact Covered California isn’t the problem, but could be part of the solution.