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States wrestle with provider network regulation.

P K O'Hare1

  • 1McDermott, Will & Emery, Washington, DC, USA.

Healthcare Financial Management : Journal of the Healthcare Financial Management Association
|July 6, 1996
PubMed
Summary

States are evaluating provider network participation in risk-based healthcare arrangements. This is influenced by market trends and new regulations impacting provider-sponsored networks (PSNs) in Medicare risk contracts.

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Area of Science:

  • Healthcare policy
  • Health economics
  • Insurance regulation

Background:

  • Increasing market pressures are driving interest in provider network participation in risk-based arrangements.
  • The National Association of Insurance Commissioners recommended state insurance regulation for provider networks in risk arrangements.
  • Federal legislation now permits provider-sponsored networks (PSNs) to enter Medicare risk contracts.

Purpose of the Study:

  • To examine the considerations states face regarding provider network participation in risk-based arrangements.
  • To analyze the impact of market realities and recent regulatory developments on this issue.

Main Methods:

  • Policy analysis of state-level considerations.
  • Review of market trends in healthcare provider networks.
  • Examination of recent federal and state regulatory changes.

Main Results:

  • States are actively considering policies on provider network involvement in risk-based payment models.
  • Market dynamics and regulatory shifts are key drivers of these policy discussions.
  • The emergence of provider-sponsored networks (PSNs) in Medicare presents new regulatory challenges.

Conclusions:

  • State-level decisions on provider network participation in risk-based arrangements are critical.
  • Understanding the interplay of market forces and regulatory frameworks is essential for effective policy development.
  • The landscape of healthcare provider networks and risk-based contracting is evolving rapidly.

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