Making ACA Coverage a Reality - A National Examination of Provider Network Monitoring Practices by States and Health Plans (2014)

Principal Investigator: Karen Brodsky, MHS, Health Management Associates

This project will improve the ability of states to track and enforce provider network access compliance, as well as the ability of health plans to maintain good network access and to demonstrate their compliance to states. The researchers will develop and conduct two online surveys to examine the strengths and weaknesses of the provider network monitoring activities of state departments of insurance, Medicaid agencies, marketplace plans, and Medicaid plans. One survey will inquire about the current measures, standards, and practices that states use to monitor the provider networks of qualified health plans (QHPs) and Medicaid managed care organizations (MMCOs), and about common barriers to collecting and analyzing provider network information. The second survey will inquire about the current measures, standards, and practices used by QHPs and MMCOs in submitting network information to states and about challenges that plans face in completing this work. Following the online surveys, the researchers will develop a follow-up telephone survey for a subset of respondents to obtain additional insights into the barriers and opportunities related to their network monitoring and reporting activities.

Publications

Provider Network Adequacy Monitoring: Findings and Recommendations from the 2015 Robert Wood Johnson Foundation-Funded Survey of States and Health Plans
(December 2015, Webinar)

Making Affordable Care Act Coverage a Reality: A National Examination of Provider Network Monitoring Practices by States and Health Plans
(October 2015, Final Report)

Making ACA Coverage a Reality-A National Examination of Provider Network Monitoring Practices by States and Health Plans
(June 2015, Presentation at State Health Research and Policy Interest Group Meeting)

Making ACA Coverage a Reality-A National Examination of Provider Network Monitoring Practices by States and Health Plans 
(October 2015, Presentation at National Academy for State Health Policy)