Healthcare Spotlight: Operational Readiness for Narrow Networks
- HEALTHCARE SPOTLIGHT 1
- Executive Insights
In preparing for the 2016 benefit year, are you operationally ready for your narrow network products? The implementation of narrow network products came with difficult lessons for many health plan clients in 2015, including gaps in prior authorization processes, benefit design, network access and claims logic.
L.E.K. recommends that health plans introducing narrow network products establish the appropriate review and approval processes for downstream procedures and referrals to ensure that the process of care remains in network. In this Executive Insights "Healthcare Spotlight," learn how to manage out-of-network (ONN) utilization tightly and prepare for when members do try to use ONN services. Setting the precedent for the benefit period now could save money in the long run.