The “Any Willing Provider” (AWP) doctrine represents one of the most significant regulatory constraints on managed care network design in states that have adopted it. Kentucky's AWP statutes — among the most comprehensive in the country — require health plans to contract with any provider who meets the plan's standard terms and conditions, fundamentally challenging the selective contracting model that has been central to managed care cost management since the 1980s.
What “Any Willing Provider” Means
Traditional managed care network design relies on selective contracting: plans negotiate with a subset of available providers, offering them patient volume in exchange for discounted rates and compliance with utilization management requirements. Providers outside the network are either excluded entirely or covered at significantly higher cost-sharing levels, creating financial incentives for members to use in-network providers.
AWP statutes disrupt this model by requiring plans to accept any provider who is willing to meet the plan's standard contract terms. Under a strict AWP regime, plans cannot exclude providers from their networks based on cost, quality, or strategic network design considerations — they can only exclude providers who fail to meet objective credentialing and quality standards.
Kentucky's AWP statutes apply to a broad range of provider types, including physicians, hospitals, pharmacies, and ancillary providers. The statutes include both a general AWP requirement and specific provisions for pharmacy networks — the latter being particularly significant given the role of pharmacy benefit managers (PBMs) in managing drug costs through selective pharmacy contracting.
The Tension Between Access and Cost Management
AWP statutes reflect a fundamental tension in healthcare policy between two legitimate goals: maximizing patient access to providers of their choice, and enabling health plans to manage costs through selective contracting and network design.
Proponents of AWP argue that selective contracting creates access barriers — particularly in rural areas where the number of available providers is limited — and that patients should have the right to see any qualified provider without financial penalty. They also argue that AWP promotes competition among providers by preventing plans from using network exclusion as a tool to favor certain providers over others.
Opponents argue that AWP undermines the cost management mechanisms that make managed care viable, leading to higher premiums and reduced affordability. They point to research suggesting that states with AWP laws have higher healthcare costs than states without them, and that the inability to selectively contract reduces plans' leverage to negotiate lower rates and enforce quality standards.
Implications for Provider Organizations
For provider organizations operating in Kentucky or other AWP states, the regulatory environment creates both opportunities and obligations. The opportunity: AWP statutes give providers the right to demand network inclusion on standard terms, eliminating the risk of being excluded from a plan's network for competitive or strategic reasons. This is particularly valuable for smaller provider organizations that might otherwise lack the negotiating leverage to secure network contracts with dominant health plans.
The obligation: AWP statutes typically require providers to accept the plan's standard contract terms as a condition of network inclusion. This means that providers cannot use the threat of network exclusion as leverage to negotiate above-standard rates — they must accept the plan's standard fee schedule or decline to participate.
Lessons for National Managed Care Strategy
Kentucky's AWP experience offers important lessons for managed care organizations and provider groups operating nationally. States with AWP laws require fundamentally different network strategy than states without them — plans must design their cost management approaches around utilization management, value-based payment, and quality incentives rather than selective network contracting.
For provider organizations, AWP states offer a more level playing field in network negotiations, but also require a different approach to contract optimization. In AWP states, the focus shifts from securing network inclusion to negotiating the best possible terms within the standard contract framework — including rate escalators, quality bonus provisions, and favorable billing and payment terms.