A proposal by California’s insurance exchange has brought health insurers and providers together in opposition. The plan is to cut hospitals from the exchange network if they do meet performance targets.
NPR says that it appears to be a US-first and would require insurers to report those providers which are considered outliers in terms of cost or quality. Hospitals would be first to be targeted, in 2018, with doctors and medical groups ranked later. Those that do not measure up would be removed from health plans by 2019.
Health insurer’s carriers are not happy about being forced to reveal their negotiated rates with providers but Covered California says it is time to move beyond enrolment to provide better service for consumers.
California is definitely ahead of the pack when it comes to taking an active purchasing role, and exclusion is a pretty big threat.