Anthem Obamacare plan backs off ‘narrow network’
St. Vincent's 22 hospitals and nearly 900 physicians on
Before that, the only central
It's a significant strategy shift for Anthem, which has tried to limit the number of providers in its exchange networks in exchange for paying them lower fees, betting lowest-priced plans on the exchange would gain the most customers.
Anthem requested a discount from St. Vincent, according to Dr.
"We have to consider a multitude of factors," he said. "Does it add an attractiveness for our customers? Does it add an attractiveness for our brokers?"
In a written statement, she said St. Vincent decided to join Anthem's network because being out of it was causing problems for patients.
Anthem's move to broaden its provider network mirrors what other "narrow network" health plans in
But before the plan was a year old, it had to add other hospitals and physicians because employers demanded it. Likewise,
"It was employers that simply said, 'We like your product. It's a good price. But if it's our only plan, we'll have unhappy employees,' " said
That pressure is lessened when narrow-network insurance plans are offered as one choice among many, as is the case on the Obamacare exchange, Slabosky said. But when families purchase insurance, narrow networks can still be a problem.
"There was frequently a situation where one spouse would be going to IU or Methodist, and the other spouse would be going to a physician at
Lee said Anthem's deal with St. Vincent was spurred by insurance brokers saying they could sell more of Anthem's Obamacare policies if they included one of the hospitals in
Previously, Anthem's exchange policies would cover at a discounted rate any specialized services - such as inpatient pediatric care - that were not provided by one of its exchange providers. Even so, some customers were still opting for exchange plans that included
Anthem talked with St. Vincent about joining its Obamacare network in 2013, with Anthem particularly interested in the many small hospitals St. Vincent has in rural counties. But St. Vincent leaders worried agreeing to the lower discounts Anthem wanted would pressure St. Vincent's prices on its other contracts with Anthem.
Even so, Lee said he expects Anthem's network for Obamacare policies to remain more limited than the broad choice of providers it offers to employers.
"It does appear that price is the number one priority for exchange customers," he said. "A narrow network may likely be a continued desirable feature to help drive deeper discounts."
Anthem's broadening of its provider network comes after many other health insurers selling Obamacare policies tried to counter Anthem's narrow network with broader choices of providers.
In 2015,
Anthem remains by far the largest player among individual Obamacare plans, with more than 100,000 customers. But its share of the overall market has slipped to about 50 percent this year, compared with about 75 percent last year.
While Anthem had the lowest-priced plans in nearly all
The average premiums requested by nine insurers selling on the Obamacare exchange show Anthem in sixth place, ahead of only UnitedHealthcare,
But the low-cost competition will get a lot thicker in 2016. IU Health Plans, the insurance arm of
That combination should allow IU Health Plans to sign up nearly 5,200 customers in 2016, its insurance filing predicts.
Also,
"We did not have our own proprietary data from which to develop rates, either for 2014 or 2015. Now, with a full year of actual experience, we are able to refine and correct assumptions that had been made previously based solely on publicly available information and studies," wrote
Kleymeyer, the benefits broker, said he expects all the health plans to keep working to find the right balance between price and provider choice.
"The ACA exchanges are still very much in their infancy and, like all goods and services sold in a marketplace, there will continue to be an ebb and flow between price and product as the market matures," he said.
Obamacare market shares
Insurers selling health insurance that complies with Obamacare's new rules have signed up more than 210,000 customers in
Insurer ... 2015 Indiana enrollment
Anthem ... 100,000
CareSource ... 34,265
UnitedHealthcare ... 28,440
Coordinated Care-Celtic ... 384
Indiana
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