Over the past three years, advocates across the country have celebrated the plummeting number of uninsured people while working to identify and address the remaining challenges and barriers that health care consumers face. While early evidence found most people who signed up for health insurance were able to find a doctor and get a timely appointment for primary care with relative ease, advocates noticed some concerning trends: provider networks were narrowing and provider directories, the main tool that consumers use to find out information about which doctors are in their plan, were error-ridden.
These trends were not limited to one state or region, and setting new model network adequacy standards and consumer protections became a priority at the National Association of Insurance Commissioners (NAIC), which issued its network adequacy model act this past fall.
At Georgians for a Healthy Future, concerns about network adequacy and provider directory problems came onto our radar during the first open enrollment period when consumers began contacting their enrollment assisters with network issues. Health care provider associations in Georgia also expressed concerns about network adequacy. Last year, a national report found that Georgia had the highest percentage of narrow networks, or networks with a very limited number of health care providers, of any state at 83 percent.
In 2015, the Georgia Senate created a study committee to explore issues around provider and consumer protections, including network adequacy. I was honored to be appointed to this committee to bring the consumer perspective to the process. Additionally, our Health Policy Analyst Meredith Gonsahn researched these issues in detail and delivered testimony and policy recommendations during the study committee process. The committee’s final report referenced concerns about provider directory inaccuracies and recommended a careful review of the NAIC model act. While the Legislature did not have the appetite to take on network adequacy in all of its complexities this year, we knew these important consumer issues had the attention of policymakers.
We did not want to lose this momentum. So as consumer advocates we thought carefully about the steps that health care consumers take when they review their options, select a health plan, and seek to access a medical provider through that plan. We kept coming back to provider directories as the first step. Consumers can easily obtain information about premiums, deductibles, and benefits when shopping for insurance. However, finding information about provider network size and composition is more challenging, and provider directories are the primary tool available for that information. Unfortunately, a secret shopper survey we conducted found three-quarters of directory listings contained at least one error and one in five providers listed in the directory weren’t even in the network.
Model language about improving provider directory accuracy and usability was included in the NAIC act, and our friends at Families USA put a spotlight on promising practices from a range of states to help clean up provider directories and make them useful tools for consumers. In the fall of 2015 we began to draft legislation here in Georgia that included accuracy provisions such as requiring provider directory audits, usability provisions such as requiring directories to be searchable, and a protocol for protecting consumers when they rely on inaccurate information contained within a directory.
When the 2016 legislative session began in January, we identified a bill sponsor who championed this legislation and brought all stakeholders to the table to ensure it was something that could garner the necessary support. To inform this process and engage other community partners and advocates, advocates held a policy forum in February to release recommendations on network adequacy and provider directories and discuss the legislation. As the bill moved through the General Assembly, state regulators lent support to the legislation and it received attention in the local media.
Moving this bill across the finish line involved negotiation among multiple parties and support from our partners in the advocacy community. We were also fortunate to have a dedicated legislative champion and continued engagement from the DOI. Still, there are elements of the bill that may need to be clarified when rules are promulgated this summer or even in next year’s legislative session. Nevertheless, a strong piece of consumer protection legislation sparked by consumer health advocates passed both the state House and Senate overwhelmingly and now heads to the governor for his signature.
Cindy Zeldin Executive Director, Georgians for a Healthy Future