The Texas legislature in their wisdom injected a dose of competition into the managed care network world with this year’s passage of SB926 which allows health plans to steer plan members to lower cost in-network providers.
The presumption is not all in-network providers are paid the same. That is true. Some are paid more, and some are paid less. Under SB 926 there will be added pressure among higher cost providers to reduce their fees to gain favored in-network status for stronger patient steerage for their services.
Dr. Jones’ managed care contract pays 150% of Medicare while Dr. Smith earns 80% through the same network. Under SB 926 plan sponsors can now drive steerage by placing lower or higher copays appropriately.
SB 926 – Health plan provider ranking, tiering, and steering…….
Permits health plans to steer enrollees to certain physicians and providers using incentives or tiered networks, subject to a fiduciary duty to do so only for the primary benefit of the enrollee or group contract holder.
What’s the big deal about this? We’ve been doing this for years. We’ve even blacklisted certain providers entirely, advising plan members they are on their own if they choose to use them. Why did the Texas legislature pass this bill when we’ve never needed it before? We never asked government permission we just did it. Oh, I forgot, none of our Reference Based Pricing clients (With the exception of one in 2025 who returned to the world of managed care) have accessed any managed care networks since 2002, not even physician only networks.
