Washington, DC (PRWEB) September 17, 2015
With pressure mounting to keep coverage affordable, health insurers are placing even greater emphasis on narrow provider networks for their commercial and Medicare Advantage plans. Restricting the number of contracted providers can have a dramatic impact on premiums and place pressure on high-cost hospitals to bring down their prices. But narrow networks have come under intense scrutiny from state and federal regulators, and have been the focus of state laws and legal challenges.
In the Sept. 29 webinar from Atlantic Information Services Inc. (AIS), “Narrow Networks: How to Avoid Legal, Regulatory and PR Landmines,” participants will learn how to identify and avoid pitfalls when building networks that exclude costly and/or inefficient providers.
Terese A. Mosher Beluris and Jeremy Earl of McDermott Will & Emery LLP, Tom Mikuckis of Oliver Wyman’s Health & Life Sciences practice, and Helaine I. Fingold of Epstein Becker Green’s Health Care and Life Sciences practice will present for 60 minutes and follow with a 30-minute Q&A session. They will provide valuable insights on these and related issues:
- How is network adequacy determined by federal and state regulators…for HMOs and PPOs?
- Given their role in coordinating care, what risks do health plans face when limiting primary care doctors?
- How do state any-willing-provider laws impact the degree to which a network can be narrowed?
- How are payers structuring contractual arrangements to remain in compliance with state any-willing- provider laws?
- Why must quality metrics be considered when building narrow networks?
- How can narrow networks help providers differentiate themselves as efficient health care providers?
- What steps should carriers take to avoid discrimination claims from providers?
- What are the health plan’s obligations in explaining that a provider isn’t part of the network, or from a less-preferred tier?
- What penalties do carriers face if CMS determines a Medicare Advantage plan doesn’t have enough providers accepting new patients?
Visit http://aishealth.com/marketplace/c5m21_092915 for more details and registration information.
Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for more than 25 years. It develops highly targeted news, data and strategic information for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, websites, looseleafs, books, strategic reports, databases, webinars and conferences. Learn more at http://www.AISHealth.com.