Network Adequacy in a Nutshell

Market Forces Driving Change

 
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Increased Enrollment and Trends Towards Managed Care


Competing Stakeholder Incentives


Trend Toward Tiered and Narrowed Networks


JAMA, “Adequacy of Outpatient Specialty Care Access in Marketplace Plans Under the Affordable Care Act, V. 314, No. 16, October 27, 2015

JAMA, “Adequacy of Outpatient Specialty Care Access in Marketplace Plans Under the Affordable Care Act, V. 314, No. 16, October 27, 2015

GAO Report to Congressional Requesters, GAO-15-170, “Medicare Advantage: Actions Needed to Enhance CMS Oversight of Provider Network Adequacy”, August 2015.

GAO Report to Congressional Requesters, GAO-15-170, “Medicare Advantage: Actions Needed to Enhance CMS Oversight of Provider Network Adequacy”, August 2015.

 
 

 What measures are being used to determine if networks are adequate?

 
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