Narrow-network Strategies and Incentive-based Contracts Transform the Nation’s Largest Commercial Insurer, According to a New Report from HealthLeaders-InterStudy
October 3, 2013—Nashville, Tenn. —
HealthLeaders-InterStudy, the leading provider of managed care market intelligence, finds that the nation’s largest commercial insurer, WellPoint Inc., is transforming its products—and its provider relationships—to prepare for the new healthcare paradigm in 2014. The newly released WellPoint MCO Analyzer report finds that the company has created new narrow provider networks in all 14 of its Blue Cross Blue Shield affiliate states to support narrow-network plans on the healthcare exchanges, which opened for enrollment October 1, 2013. These narrow-network plans typically exclude high-cost providers in any given region, and can thus offer lower insurance premiums for individuals and groups.
WellPoint is not the only plan relying on narrow networks to lower costs for its exchange plan offerings, but the strategy allows these low-cost networks to be offered in its other commercial products. WellPoint is already offering narrow-network products and tiered-network products in its largest market, California. WellPoint has also built up its care management capabilities through incentive-based primary care contracts that reward providers for managing the healthcare of those with chronic conditions and keeping patients compliant with their medications.
“WellPoint’s previous model was based on broad networks that included almost every local provider. Because of the changes in healthcare reform, the company is offering smaller, cost-effective network options,” said HealthLeaders-InterStudy Principal Analyst Paula Wade. “Depending on how the larger commercial market responds to the narrow-network designs, hospitals outside of the narrow networks could face some real strain.”
About MCO Analyzer
HealthLeaders-InterStudy’s MCO Analyzer is a report series profiling the nation’s top insurers, including their enrollment, market strength and competitive position in the commercial, Medicare Advantage and Medicaid segments. It also examines their pharmacy operations, care management, provider contracting and financials.