On December 8, 2015, HMA Information Services hosted the webinar, “Provider Network Adequacy Monitoring: Findings and Recommendations from the 2015 Robert Wood Johnson Foundation-Funded Survey of States and Health Plans.”
Invest in network standards. Monitor program-wide provider capacity. Increase after-hours access. Deploy data analytics. Increase states’ role in network oversight. These are some of the key findings and recommendations from the Robert Wood Johnson Foundation-funded survey of health plans and state regulators concerning provider network adequacy compliance and monitoring standards. The survey, conducted by Health Management Associates (HMA), was designed to identify important trends and potential challenges in provider access monitoring and compliance given the dramatic increase in health insurance coverage under the Affordable Care Act.
During this webinar, HMA Principals Karen Brodsky and Barbara Markham Smith outline nearly a dozen findings and recommendations, providing a roadmap for both states and health plans seeking more effective and efficient ways of ensuring adequate provider access for members. Listen to the replay and:
- Identify key differences in network adequacy compliance and monitoring standards among states and learn why a push for more standardization of methods and metrics is necessary.
- Understand the need to track provider overlap among competing health plan networks to get a true read on provider capacity in a state or region.
- Learn why health plans are increasingly including essential community providers in Medicaid, commercial and exchange networks.
- Understand health plan reports regarding where they exceed state network requirements in order to ensure better provider access.
- Find out how after-hours access is being addressed for primary care service access.
- Understand the importance of data analytics in identifying network access problems, especially the type of problems that result in increased use of emergency room and out-of-network care.
- Assess the role of state insurance regulators and the likelihood they will need to step up their involvement in monitoring network adequacy among health plans.
The slide deck for this webinar can be retrieved by clicking the “DOWNLOAD” button below.