Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Rm 428, Baltimore, MD 21205. Email:
Am J Manag Care. 2021 Apr 1;27(4):e101-e104. doi: 10.37765/ajmc.2021.88614.
In public health insurance programs, federal and state regulators use network adequacy standards to ensure that health plans provide enrollees with adequate access to care. These standards are based on provider availability, anticipated enrollment, and patterns of care delivery. We anticipate that the coronavirus disease 2019 pandemic will have 3 main effects on provider networks and their regulation: enrollment changes, changes to the provider landscape, and changes to care delivery. Regulators will need to ensure that plans adjust their network size should there be increased enrollment or increased utilization caused by forgone care. Regulators will also require updated monitoring data and plan network data that reflect postpandemic provider availability. Telehealth will have a larger role in care delivery than in the prepandemic period, and regulators will need to adapt network standards to accommodate in-person and virtual care delivery.
在公共医疗保险计划中,联邦和州监管机构使用网络充足性标准来确保健康计划为参保者提供充分的医疗服务。这些标准基于提供者的可获得性、预期的入保人数以及医疗服务提供模式。我们预计,2019 年冠状病毒病将对供应商网络及其监管产生 3 个主要影响:入保人数变化、供应商格局变化和医疗服务提供方式变化。监管机构将需要确保计划根据未提供的医疗服务导致的入保人数增加或利用率增加来调整其网络规模。监管机构还将需要最新的监测数据和反映大流行后提供者可获得性的计划网络数据。与大流行前相比,远程医疗在医疗服务提供中的作用将更大,监管机构将需要调整网络标准以适应面对面和虚拟医疗服务的提供。