- Center on Health Equity & Access
- Clinical
- Health Care Cost
- Health Care Delivery
- Insurance
- Policy
- Technology
- Value-Based Care
Will Physician Participation Impact Exchange Enrollee Treatment?
Just as a looming physician shortage threatens the effective treatment of millions of newly insured, patients may face another barrier: not enough doctors are participating in the healthcare insurance exchange networks.
Just as a looming physician shortage threatens the effective treatment of millions of newly insured, patients may face another barrier: not enough doctors are participating in the healthcare insurance exchange networks.
A severe cut in doctor reimbursements through exchange insurance plans means many practitioners are choosing not to accept exchange patients. Providers in states from New York to California have filed complaints to medical associations about the discounted rates. The question has been raised: If providers are paid less, are enrollees going to have difficulty getting physicians to accept them as patients?
Said Lynn Quincy, a senior analyst with Consumer Reports, “These consumers are buying a product, one dimension of which is to provide a network—a very important dimension.”
The Medical Society of the State of New York found that nearly half of those physicians surveyed said they had yet to choose to participate in an exchange insurance plan, and one-third were undecided. Almost two-thirds had received no information about exchange reimbursement, and those who did felt reimbursement was below that of other plan contracts.
“If you’re a physician and you’ve negotiated a rate from insurance, shouldn’t it be the same on or off the exchange?” added Matthew Katz, executive vice president of the Connecticut State Medical Society. “You’re providing the same service.”
Additionally, some doctors who are willing to treat exchange patients are unsure of what networks they actually belong to.
Patricia McLaughlin, an ophthalmologist in New York City, said, “I have patients calling my office and saying ‘Oh good, I see you’re in the network.’ I’m not sure if I am or am not at this point.”
Addressing this gap in care will be necessary to ensure that the newly insured receive adequate and timely care.
Around the Web
New Primary Care Models Could Help Physician Shortage [AJMC]
New Primary Care Models Could Help Physician Shortage - See more at: http://www.ajmc.com/focus-of-the-week/1113/New-Primary-Care-Models-Could-Help-Physician-Shortage#sthash.FTWsEsq6.dpuf
Doctors Complain They Will Be Paid Less By Exchange Plans [Kaiser Health News]
Long COVID Disparities Revealed in New Study From England
March 18th 2025A new analysis out of England shows a considerable level of uncertainty among adults who think they could have long COVID, as well that levels of the chronic condition are disproportionately higher among certain socially disadvantaged groups.
Read More
Navigating Sport-Related Neurospine Injuries, Surgery, and Managed Care
February 25th 2025On this episode of Managed Care Cast, we speak with Arthur L. Jenkins III, MD, FACS, CEO of Jenkins NeuroSpine, to explore the intersection of advanced surgical care for sport-related neurospine injuries and managed care systems.
Listen
For Neuromuscular Disease Community, an Era of Opportunities and Threats
March 17th 2025Robert Califf, MD, former commissioner of the FDA, delivered a keynote address at the 2025 Muscular Dystrophy Association Clinical & Scientific Conference that highlighted the enormous opportunities for progress in neuromuscular disease care amid a changing policy environment.
Read More
Varied Access: The Pharmacogenetic Testing Coverage Divide
February 18th 2025On this episode of Managed Care Cast, we speak with the author of a study published in the February 2025 issue of The American Journal of Managed Care® to uncover significant differences in coverage decisions for pharmacogenetic tests across major US health insurers.
Listen
