In Brief: Insurance Department Issues New Provider Network Regulations; Kaiser: Quick Followup Care Can Cut Heart Failure Readmissions

Insurance Department Issues New Provider Network Regulations

The California Department of Insurance has issued new regulations intended to strengthen the provider networks offered by health plans.

The regs, which were recently approved by the California Office of Administrative Law, require health plans to have a sufficient number of primary care and specialty providers in their network; adhere to and monitor appointment wait time standards; maintain accurate provider directories and update them weekly; and regularly report network changes to the Department of Insurance, among other requirements.

Insurers will also have to pay for out-of-network care if a patient cannot secure medically necessary services within their health plan’s network.

"Health insurers are required to develop and maintain medical provider networks with sufficient numbers of medical providers and facilities to meet the needs of their policyholders and provide accurate information about which doctors and facilities are in their networks," said Insurance Commissioner Dave Jones. "These new regulations provide consumer protections that should prevent the practice of surprising consumers with huge charges for out-of-network providers when they sought out an in-network provider."

Jones had issued the regulations on an emergency basis in January 2015 in response to the proliferation of narrow network health plans, but the OAL’s approval makes them permanent.

Kaiser: Quick Followup Care Can Cut Heart Failure Readmissions

A new study by Kaiser Permanente has demonstrated that followup care shortly after the discharge of heart failure patients can significantly curb their readmission to the hospital.

Kaiser studied nearly 12,000 of its patients admitted to their hospitals between 2006 and 2013 who were discharged back to their homes without hospice care.

Heart failure is the leading cause for hospitalization among patients over the age of 65. 

Within the Medicare program, more than 20% of heart failure patients are readmitted within 30 days of discharge, creating a significant financial burden for the program.

The study concluded that patients who received some form of followup care within seven days of their discharge cut readmissions by 19%. 

Most of the patients received care in clinics, but even a telephone call within a week of discharge also cut down on readmissions. Among the phone calls made, 45% of them came from non-physician providers trained in an outpatient heart failure protocol.

"Our study showed that the timing of follow-up after hospitalization for heart failure is an important factor. Early follow-up within seven days, even with a telephone call, was associated with lower risk of readmission, whereas follow-up after seven days was not associated with this benefit," said lead author Keane Lee, M.D., a cardiologist and research scientist with Kaiser Permanente in Northern California.

The study was published in the most recent issue of the journal Medical Care.