arrowThe ACOs offered under the ACA were sup­posed to do this, and some have.  We also saw car­ri­ers forced to reduce the net­work sizes in response to the Exchanges imple­ment­ing for­mal guide­lines on rates and rate increas­es.  Now the car­ri­ers are think­ing about doing this as a gen­er­al practice…which is fun­ny, because that is what they were sup­posed to be doing when they start­ed HMO and PPO plans years ago.  By mak­ing the lists more “exclu­sive” they could extract greater dis­counts.  Then the lists expand­ed and costs con­tin­ued to climb.  So now we go back to the begin­ning and see what happens…and what com­plaints will fol­low.  The dif­fer­ence these days is that the dis­count comes with reduced avail­abil­i­ty as prac­tices begin to fill.  Then what?