The Rheumatologist
COVID-19 News
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Axial Spondyloarthritis Resource Center
    • Gout Resource Center
    • Psoriatic Arthritis Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
    • Interprofessional Perspective
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Systemic Lupus Erythematosus Resource Center
      • Rheumatoid Arthritis Resource Center
      • Gout Resource Center
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / Do Tiered Physician Networks Help or Hurt? What Rheumatologists Should Know

Do Tiered Physician Networks Help or Hurt? What Rheumatologists Should Know

January 8, 2016 • By Richard Quinn

  • Tweet
  • Email
Print-Friendly Version / Save PDF

GENERIC_Legal_500x270Tiered, narrow, high-value or high-performance physician networks are growing in popularity. Nearly one in four employer-sponsored health plans included such options in their 2015 coverage, according to new data from the annual Kaiser Health Benefits Plan Survey. These programs offer incentives to patients for access to what payers describe as “high quality.”

You Might Also Like
  • Hospital-Owned Physician Practices Linked to Higher Prices
  • Patients Steered to Fewer Pharmacies May Fill More Prescriptions
  • A Focus on Building & Maintaining Social Support Networks for Rheumatologists & Patients
Also By This Author
  • From the Expert: Dr. Anne Bass Addresses Fellowship Training in Rheumatology

Continued expansion of these networks—and the manner in which payers determine quality—should concern rheumatologists nationwide, says Douglas White, MD, PhD, chair of the ACR’s Committee on Rheumatologic Care.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

“This is just one in a long list of setbacks all over the U.S. that threaten rheumatology patients,” Dr. White says. “Don’t be fooled. Regardless of claims about high-performance and quality, value and patient choice, this and similar programs have one goal and one goal only: near-term cost reduction.”

Although he concedes rising healthcare costs are a serious problem and rheumatologic care can be expensive, Dr. White says he hopes insurers will work with physicians and patients to lower costs, “as opposed to announcing unilateral policies.”

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

One insurer-sponsored analysis states, existing research focused on “tiered and narrow network design is most compelling when considering the demonstrated premium and total cost of care savings to plan sponsors and enrollees.”1 Another report states that tiered and narrow networks “produce premium reductions of 5% to 20% or more when compared with broad, open access plans.”2

“The root of the problem lies in the definition, or lack thereof, of quality of care,” Dr. White adds. “No one—not yet, anyway—really knows or can agree on how to measure quality of care in rheumatology. Until we can figure out how to measure quality, programs like this will indiscriminately limit patient access to expensive care, whether that care is necessarily expensive (and high value) or expensive due to waste and inefficiency (low value).”

Dr. White says all rheumatologists need to “pay attention” to measurements and peer-to-peer comparisons.

ad goes here:advert-3
ADVERTISEMENT
SCROLL TO CONTINUE

“Tiered networks are an old adversary in new clothes, designed to cut expenses by excluding high-cost providers while maintaining the appearance of network adequacy,” he says. “I encourage all providers to engage with the ACR, with state rheumatology societies, with legislators and with insurance carriers to let our voices be heard in the debate around what constitutes quality of care.”

Richard Quinn is a freelance writer in New Jersey.

References

  1. America’s Health Insurance Plans. High-performance provider networks: Ensuring affordable, high-value health care. AHIP Coverage. 2013 Dec 4.
  2. America’s Health Insurance Plans. Milliman report: High-value healthcare provider networks. 2014 Jul 3.

Pages: 1 2 | Single Page

Filed Under: Legislation & Advocacy, Professional Topics Tagged With: costs, Health care, Health Insurance, healthcare cost, Tiered Physician Networks

You Might Also Like:
  • Hospital-Owned Physician Practices Linked to Higher Prices
  • Patients Steered to Fewer Pharmacies May Fill More Prescriptions
  • A Focus on Building & Maintaining Social Support Networks for Rheumatologists & Patients
  • What Rheumatologists Need to Know About the Physician Payment Sunshine Act

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

ACR Convergence

Don’t miss rheumatology’s premier scientific meeting for anyone involved in research or the delivery of rheumatologic care or services.

Visit the ACR Convergence site »

Meeting Abstracts

Browse and search abstracts from the ACR Convergence and ACR/ARP Annual Meetings going back to 2012.

Visit the Abstracts site »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2022 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.