Dear Mr. Chairman,
Thank you for inviting the Alliance of Specialty Medicine to provide comments and recommendations related to
the Senate Finance Committee’s effort to produce patient-focused health care legislation. The Alliance did not
support the Affordable Care Act and at the time provided substantive comments regarding several provisions of
concern. We appreciate your goal to involve stakeholders and to establish an open and orderly process.
Recognizing that comprehensive health reform is likely to be accomplished in several phases, our comments are
organized into what we believe may be relevant to the budget reconciliation process versus regular order. In
addition, attached is information related to a physician survey conducted this year by the Alliance related to timely
access to specialty care.
Budget Reconciliation
Health care plans in the private market should provide timely access to specialty care. Key to this theme is
addressing the increasing issue of narrow insurance networks.
Ensure Network Adequacy
Patients face access to care barriers due to narrow health plan networks. Many times, unknown to patients,
entire specialties are excluded from health plans or the number and mix of specialists and subspecialists are
not adequate to meet the needs of the insured population. Networks should be sufficiently robust to ensure
that an appropriate number of specialists and subspecialists per enrollee are available. Additionally, network
directories should be updated in real-time and provide patients with clear, concise, and accurate information.
Finally, decisions to remove a physician from the network without cause should not be made in the middle of
a contract year. We urge the committee to ensure appropriate oversight to hold insurers accountable to
ensure patients have timely access to the right care, in the right setting, by the most appropriate health
care provider.
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Read full letter here
