The so-called tiered plans have found an audience despite fierce opposition from hospitals left out of the network and lawmakers worried about their economic impact on big employers in their districts. But insurance industry officials said
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"A tiered product is something the marketplace was looking for and something the marketplace has accepted," said
Kobylowski was among the health care experts who spoke to industry officials and policymakers Tuesday about tiered networks at the
They focused on what could be an antidote for the Patient Protection and Affordable Care Act's marketplace for consumers not covered by
Consumers are getting ready to wade through the process again. Open enrollment for Obamacare begins
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Five takeaways from the conference:
1. Tiered plans aren't sweeping the nation.
Providers are split into Tier 1 and Tier 2. Consumers can see any that they wish, but they pay less out of pocket for providers that are considered Tier 1. In
Unlike an HMO, consumers don't need a referral to see a specialist. But it is a bid by insurers to lower the cost of health care by narrowing the network of providers consumers can see. Studies have found that narrow-network plans are 6.7 percent cheaper, said
Still, only 15.5 percent of Obamacare insurance plans are considered tiered networks, Hempstead said.
"It's not a common thing," she said. "An awful lot are in
Horizon has said it enrolled 189,000 individuals, including 41,258 who previously didn't have insurance, for its tiered plan called Omnia, making it the state's most widely held insurance plan for 2016.
The reason isn't complicated.
Horizon requested a premium increase for 2017 of less than 5 percent for its Omnia plan, far lower than its counterparts both in
"We heard form the marketplace that was an unsustainable number, that's an unsustainable growth rate," Conlin said. "They would be open to other products."
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3. If it's so great, why did lawmakers in
When AmeriHealth New Jersey introduced its tiered network in for 2014, it barely registered. When Horizon introduced Omnia last year, it sparked lawsuits and legislative hearings.
It shouldn't have been a surprise. Horizon covers 60 percent of the individual market, compared with
CentraState and five other hospitals have sued in part because consumers might think Tier 2 might be lower quality. But it raises a question of whether there is room for everyone.
"I'm not trying to be a cold-hearted capitalist," Assemblyman Jack Ciatterelli, R-
4. The tiered network isn't as innovative as it sounds.
The health-care system is making a transition from rewarding hospitals and doctors for the services they provide to rewarding them for the quality of care. The tiered network, however, still is a fee-for-service model. Health-care providers agree to take less in reimbursement in exchange for more patients, said
It is a bit tone deaf, he said. In the not-so-distant future, consumers will be more engaged in their own health care and providers will be rewarded based on the quality of their care.
"All (a tiered network) is is a tool to shift volume from Provider A to Provider B," Maron said. "There's no magic to it."
5. There might be a little magic to it.
The fee-for-service model might be on the way out. But Omnia also features a partnership between Horizon and RWJBarnabas, allowing them to share data that can help them better manage patient care. It is an example of insurers and health care providers collaborating more closely, officials said.
As health care moves forward, it is increasingly apparent that the best way to avoid an expensive bill is to not get sick.
"It is a transition, but we're moving in the right direction," said
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