Timely access to healthcare services is an important enabler of positive health outcomes. Access to care remains a significant challenge in the United States where, historically, approximately 16% of adults Americans have reported long wait times and difficulty getting appointments for routine care as soon as needed. Demand for healthcare services has grown over the past decades, although supply of qualified providers and healthcare access points has not kept pace. This lagging capacity has contributed to delays in receiving care, often resulting in adverse health outcomes and higher healthcare expenditures.
As payers and providers work to develop and maintain their provider networks, they often face limited options in how they can meet access standards mandated by state and federal regulators. Selecting the appropriate providers to address geographic network requirements is a crucial strategic decision. Payers must develop a deep understanding of how the often-limited pool of providers in a market can impact the plan’s Medicare star rating and other quality and performance measures.
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