California’s Message To Hospitals: Shape Up Or Lose ‘In-Network’ Status

California is starting to push hospitals throughout the state to lower their rates of medically unnecessary C-sections.

Thanasis Zovoilis/Getty Images


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Thanasis Zovoilis/Getty Images

California is starting to push hospitals throughout the state to lower their rates of medically unnecessary C-sections.

Thanasis Zovoilis/Getty Images

Covered California, the state’s health insurance marketplace under the Affordable Care Act, has devised what could be a powerful new way to hold hospitals accountable for the quality of their care.

Starting in less than two years, if the hospitals haven’t met certain designated targets for safety and quality, they’ll risk being excluded from the “in-network” designation of health plans sold on the state’s insurance exchange.

“We’re saying ‘time’s up,’ ” says Dr. Lance Lang, the chief medical officer for Covered California. “We’ve told health plans that by the end of 2019, we want networks to only include hospitals that have achieved that target.”

Here’s how hospitals will be measured: They must perform fewer unnecessary cesarean sections, prescribe fewer opioids, and cut back on the use of imaging (X-rays, MRIs, and CT scans) to

Article source: https://www.npr.org/sections/health-shots/2018/05/23/611975420/californias-message-to-hospitals-shape-up-or-lose-in-network-status?utm_medium=RSS&utm_campaign=affordablecareact

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