Narrow Networks in Obamacare Plans Could Lead to Better Provider Teamwork

The nation’s attention has been focused on Affordable Care Act (aka Obamacare) enrollment numbers. The two key questions are 1) How many of the uninsured would purchase health insurance, and more importantly, 2) have enough young people (read: healthy who don’t consume much health care) enrolled to keep overall payouts down and plans viable? 

The answer to that question is “yes.” Over 8 million have signed up through the state and federal insurance marketplaces. Another 5 million purchased plans outside the exchanges. While the data is not complete, surveys report an overall drop in the number of uninsured. The number of young people signing up did jump towards the end of the enrollment period and the health plans seem happy with the risk pools.

So, what’s next? As discussed in a previous postconcerns about limited provider networks were likely when people began to use their new coverage. The low-cost plans offered through the health insurance marketplaces come at a price: less choice. The privilege of seeing any doctor you want will cost more. However, is the freedom to assemble your own health care dream team actually good for your health? 

Anyone who’s undertaken a major home renovation knows how hard it is to manage and coordinate the contractors' work to ensure materials aren’t wasted, the plumber doesn’t ruin the freshly painted wall and the job is finished on time and under budget. It’s no different in health care. However, when doctors don’t communicate, share results and harmonize their treatment plans, more than another gallon of paint is at risk. Care coordination improves outcomes and reduces health care expenses. Redundant care is reduced and mistakes are caught before they turn tragic when patients are under a team’s care. 

The team care concept goes against our traditional view of doctors as independent experts delivering highly customized services. Think bespoke rather than mass produced. While a custom-fitted suit sounds like a great idea, consistency of outcome can suffer especially when unaffiliated specialists are needed to deliver the service. 

Dr. Jeff Brenner of the Camden Coalition of Health Partners speaks of the need to “industrialize” health care to ensure the highest quality care is delivered every time, to everyone. Over the past several decades, the quality movement has revolutionized factories and they can produce goods that are free of defects 99.99966% of the time. Health outcomes improve when the health care providers adopt a similar team-based quality approach.

Simply limiting choice to a random group of providers who offer their services at the lowest price will not improve care coordination and health outcomes. Fortunately, the ACA puts in place an array of quality measures to hold both payers and providers accountable for their results and empowers consumers to make better choices.

When picking your own team of doctors don’t forget that their ability to work together may be just as important as how each performs individually. Otherwise, quality care may be just a fantasy.