It’s no secret that access to healthcare services is a pivotal issue for many. Provider network adequacy, which ensures that health plans have enough providers to meet their members’ needs, serves as a cornerstone for healthcare access. However, the current network adequacy standards fall short in addressing how long patients may have to wait to get an appointment with their
When it comes to health plans, provider network adequacy is crucial. For most health insurance products, it is mandated by law that health insurers ensure that their networks are sufficient in size and scope to offer a defined set of covered services to their members. However, provider network adequacy does not always equate to actual member access. Fact or Myth?
When it comes to healthcare, ensuring the satisfaction and positive experience of patients or members should be a priority of networks. However, this seems not to be the case for some, particularly those that have inadequate provider networks. Contrary to what many people think, having a sufficient number of healthcare providers in a network does not necessarily mean that members
In the ever-evolving landscape of healthcare, it’s not enough to just meet standards – you need to surpass them. As a health plan looking to outshine competitors, it’s crucial to understand that being merely ‘adequate’ won’t cut it. Your aim should be to offer an exceptional service that not only meets but exceeds the expectations of your consumers. That’s where
Since its launch by CMS, Medicare Advantage (MA) has transformed healthcare in the United States. As a result, Medicare beneficiaries now have more options and insurers are competing on price and quality, which has led to lower healthcare costs and better healthcare outcomes. It seems like a win-win scenario for health plans and consumers… until you recognize which group is
CMS plays a critical role in establishing adequate standards for healthcare, especially for the underserved. This means that those who need care should be able to get it, when they need it, without unnecessary barriers preventing access to quality care. But how do those standards play out in real life? Download The PDF
The challenges of building a provider network are well-known in the healthcare industry. Network development teams must identify sufficient healthcare providers and facilities within a geographic area to meet patient needs, then recruit, contract, and credential them. If they’re building a network for Medicare or Medicaid patients, meeting adequacy requirements and submission deadlines complicate the calculations required. Only then can
Meet Grace Meet Grace. She’s a 70 year-old immunocompromised woman living in a rural area. She owns a car but doesn’t drive anymore, so she relies on her son for transportation. When she’s able to schedule her medical appointments well in advance, he’s able to take time off to drive her to them. But what happens when she comes down
Download Our Whitepaper “ Of all forms of inequality, inequality in health is the most inhumane ” There are three main contributing factors for health inequality in the U.S.² — not to mention how we structure them to serve the needs of communities. Although provider network adequacy standards exist at the federal level and are one of the ways that
