July 18, 2016
Several U.S. states currently have primary care and specialty physician supply rates that fall well below the national average supply rate. For example, the supply of primary care physicians in Mississippi is 71 percent of the national average. The supply of psychiatrists in Indiana is 58 percent of the national average.
There is a high degree of variability by state in the number of U.S. Department of Health and Human Services-designated health professional shortage areas (HPSAs). Such shortages constrain the ability of health plans to establish high-value provider networks.
Network adequacy standards should take into account differences in physician supply and distribution across geographic areas, such as differences in the number of providers in urban versus rural areas.
Health plans are required to meet network adequacy standards established by either the Affordable Care Act (ACA) or accreditation organizations such as the National Committee on Quality Assurance (NCQA) and Utilization Review Accreditation Commission (URAC). Network adequacy standards are intended to ensure that health plan provider networks offer consumers access to sufficient numbers and types of providers. Low provider density can adversely affect a plan’s ability to meet state-level standardized cutoffs for the number and types of physicians in a plan’s network. A lack of available primary care physicians or specialists in a geographic area also impacts a plan’s ability to establish high-value networks.