Watch Out: Employer Health System Networks Are Getting Tighter

The pressure to demonstrate the value you provide to employers, compared with telemedicine, on-site clinics, and other venues for on-demand primary care, is increasing as employer health system networks continue to become more exclusive. An article posted recently by HealthLeaders suggests that employers and insurers believe tightening their provider selections will raise quality and cut costs. Regardless of whether that logic proves fruitful in the end, the result today is that provider networks are smaller. Worker’s have fewer providers to choose from—meaning even your most loyal patient-customers could be forced to go elsewhere if their claim is work-related. Three years ago, 60% of plans offered under the Affordable Care Act (also known as “Obama Care”) were structured in such a restrictive way; today, that figure is up to 72%. “These narrow network plans include health maintenance organizations and exclusive provider organizations (EPO) that limit medical care provider choices to their networks,” according to the article. “The remaining 27% of ACA health plan choices for 2019 are preferred provider organizations (PPO) or point-of-service plans that allow patients to go outside of a network for treatment but generally not for a discount.” That doesn’t leave much for urgent care operations that haven’t demonstrated value to the decision-makers’ satisfaction. This is especially perilous for urgent care operations that offer occupational medicine services as a significant part of their revenue stream. If that’s you, don’t get caught outside the bubble; collect as much data as you can to show the value you bring to the table, both in terms of outcomes and realized and potential cost savings.