Checklist for a Health Plan Provider Network that Adequately Serves Diverse Consumers

People of color continue to experience disparities in health care and health outcomes. Even when they are insured, minority populations may continue to face barriers to obtaining good health care. One common barrier is the limited availability of health care providers and facilities in many communities of color.

By creating robust provider networks, insurers can help consumers in communities of color gain access to health care that is timely, high-quality, language-accessible, and culturally competent. When the networks are adequate in size, composition, and quality, they can improve access to care for these communities. To adequately meet the health care needs of minority populations, networks must include at least the following components:

1. Adequate number of providers: Networks should include a sufficient number of providers to ensure enrollees’ access to a regular source of primary care and sufficient access to other providers and facilities as needed.
2. Adequate types of providers: Networks should include different types of providers to address enrollees’ full range of health care needs. Networks must also include essential community providers. (These are providers who serve predominantly low-income, medically underserved individuals and are mandated for inclusion by the Affordable Care Act.)
3. Adequate geographic distribution of providers: Not only should a network have a sufficient number and array of providers, these providers should also be geographically distributed to allow individuals in diverse areas to reach them without having to travel unreasonably far from their homes or workplaces.
4. Accessible hours: For a network to provide accessible care to diverse populations, it should include providers who are open during non-traditional business hours to accommodate consumers who do not have time-off flexibility during business hours.
5. Timely access to care: Networks should ensure that consumers do not have to wait unduly long to receive necessary care. Therefore, networks should meet standards to ensure that appointments are available to enrollees within a reasonable amount of time.
6. Language-accessible and culturally competent care: Networks should include providers who speak the same languages as their patients, or at least make high-quality language assistance services available. Networks should also include providers who are culturally competent and understand the unique needs of their patient population. Consumers are more likely to seek care from and follow the advice of providers who speak their language and understand their culture.
7. Accurate information about providers: Consumers need access to accurate, up-to-date information about which providers are in a plan’s network so that they can understand their options for care and avoid unintentionally visiting more costly out-of-network providers. To best serve diverse consumers, provider directories should also indicate what languages other than English (if any) providers speak, and directory information should be available in multiple languages.

To learn more about improving health insurance provider networks to address the unique needs of communities of color, see our issue brief: Network Adequacy and Health Equity: Improving Private Health Insurance Provider Networks for Communities of Color