Dear Partners,
As millions of people begin to use their new health insurance plans, there will be an increased focus on the benefits provided to consumers, access to those benefits, and how consumers feel about their available providers. These are all components of network adequacy and an area where advocates are positioned to weigh in.
Network adequacy is the ability of a health plan to give enrollees timely access to enough in-network providers, including primary care and specialty physicians, as well as other important health care services. We are now seeing many states struggle with networks that may not meet the needs of consumers.
The ACA outlines network adequacy criteria, but these standards are not specific. Consumer advocates have an opportunity to push for more robust network adequacy standards. To support this work, Community Catalyst has developed a number of materials to guide consumer advocates:
- Network Adequacy: What Advocates Need to Know. This brief provides an overview of network adequacy requirements outlined in the ACA for qualified health plans (QHPs) and other standards in private insurance markets, Medicaid, and Medicare.
- Finding Common Ground: Network Adequacy Principles. This document provides a set of network adequacy principles to unite consumer groups in their advocacy for network adequacy standards that ensure affordable access to the highest quality providers.
- Educating Policymakers about Network Adequacy – Talking Points for Advocates. These talking points help explain the issue to policymakers and can be tailored to your state.
- Improving Network Adequacy: Ideas for Advocacy Strategies. This brief highlights important steps during the planning phase and ideas for advocacy strategies to help advocates in this work.
We hope you will find these materials helpful as consumers begin accessing health care services under ACA programs. We would love to hear how you have used any of these tools and resources. Please contact Quynh Chi Nguyen, at qnguyen@communitycatalyst.org with any questions or feedback.
Thank you for your continued advocacy,
The Community Catalyst Private Insurance Team