Credentialing Practices of Managed Healthcare Organizations

There is a need for healthcare reform. In 2010, the United States Census Bureau reported there were 49.9 million people with inadequate or no healthcare insurance. Most of these individuals were living in a healthcare provider shortage area. In 2009, the National Nursing Centers Consortium published an article on credentialing practices of Managed Health Care Centers/Health Management Organizations in regards to the use of certified registered nurse practitioners. A major focus priority of the 2010 Healthy People objectives is to eliminate health disparities. The information that will be produced from this study will give insight into how the health disparities of these 49.9 million individuals in the U.S. can be resolved. According to the Kaiser Family Foundation, there were 167,857 nurse practitioners in the United States in 2010. The American Academy of nurse practitioners (2011) reported that there was a 75% increase in the number of nurse practitioner graduates with 9,203 graduating in 2009-2010 academic year. The 2011 follow-up study will gather information on the major insurance companies in the United States regarding how they have addressed this gap of primary care providers. This 2011 follow-up study used a purposive sampling to determine the 500 insurance companies to contact, with no more than 10 companies per state. The selected companies were polled by contacting their credentialing centers and questioning them on their policies regarding credentialing and reimbursement of certified registered nurse practitioners as primary healthcare provides. The data shows an underutilization of nurse practitioners in the primary care arena.