Oregon looks at regulating private insurers to ensure their networks have enough doctors

Health Care Associated Press

Oregon insurance regulators are seeking the authority to require private insurers to have enough doctors and other health care providers to adequately serve all their customers.

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The move comes as a growing number of insurance companies seek to save money by shrinking the number of providers in their network. Regulators also say consumers need more transparency when shopping for insurance, including information about which doctors are covered and whether they are accepting new patients.

The Oregon Insurance Division has created a task force that is working on a bill for the 2015 Legislature to consider. The group, which includes representatives from many of Oregon's insurance companies and from various sectors of the health care industry, will meet Thursday.

"We're looking to make the shopping experience — and also using your health plan — a better experience for consumers, so they get accurate information and can make decisions that are appropriate for their own care," said Gayle Woods, a senior policy adviser at the Insurance Division.

Nationally, some insurance companies are lowering costs by culling their list of contracted doctors and hospitals, shedding higher-cost providers and gaining negotiating leverage with those that remain.

The task force is still negotiating the specific proposal to be presented to lawmakers. The current draft suggests two ways for insurers to meet the mandate for network adequacy.

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They could meet a standard based on existing federal requirements for companies offering Medicare Advantage plans. The Medicare requirements look at the number of providers as well as the travel time and distance, but state officials say they would likely modify them to fit the needs of the commercial insurance market.

Alternatively, insurers could meet the mandate through another method, such as measurements of the health of their customers.

If lawmakers sign off, insurance regulators would then decide on specific criteria for measuring compliance.

Insurers are hoping state regulations don't add new red tape or prevent them from selling so-called narrow-network plans.

"Our hope is that any new state network adequacy requirements would add additional value for members and work with the existing federal requirements without adding any unnecessary complexity," said Peter McGarry, vice president of the provider network at Pacific Source Health Plans.

Cheryl Vandemore, chief marketing officer for Health Republic, a small nonprofit health plan in the Portland area, said overseeing network adequacy "seems like a legitimate role" for insurance regulators.

"We definitely think the public needs someone looking out for them, at least so they know what they're buying and somebody isn't using a strategy that's going to deny them care when they need it," Vandemore said.