The exchange's claim of broad physician participation

June 11, 2013

Most concerning about the announcement is Covered California’s claim that more than 80 percent of California’s practicing physicians will be available through Covered California products. There is no indication of how they arrived at this percentage, and such a projection would require reliance on a number of assumptions. The network projections appear to assume that all providers contracted with the issuer’s current individual and small group commercial products will participate in the Covered California products.

During the Covered California press event announcing the selected plans, Molly Coye, M.D., chief innovation officer of the UCLA Health System, was introduced as speaking on behalf of providers. She stated that the broad participation of physicians and hospitals in Covered California is evidence that “we accepted the challenge” of bringing value to consumers through increased affordability and quality.

Board Chair Diana Dooley and Peter Lee emphasized this message in their responses to later questions around physician shortages, essentially stating that shortages would not impact Covered California any more than the broader market.

Lee, Covered California executive director, stressed that bidding plans had to meet state standards for network adequacy and that Covered California “did a detailed review of the mix of doctors and hospitals proposed for each health plan in every region,” adding, “In many cases, we required plans to add medical groups or hospitals to their networks.”

Of particular interest, he stated that “basic networks are complete,” but health plans will be finalizing their networks with regulators in June and Covered California will be making a full list of exchange providers available in July. Covered California claimed among its providers:

  • Many of the state’s leading academic health systems,

  • Many large physician groups

  • Six of the 17 Medicare Shared Savings ACOs in California

  • Five of the six Medicare Pioneer ACOs in California



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