Narrow Networks On The Health Insurance Marketplaces: Prevalence, Pricing, And The Cost Of Network Breadth

Dafny, Leemore; Hendel, Igal; Marone, Victoria; Ody, Christopher

doi:10.1377/hlthaff.2016.1669

Cited by 55 publications

(56 citation statements)

References 5 publications

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“…One such example is the breadth of the provider network. Evidence from the 2017 Marketplaces suggests that BCBS plans tend to have broader networks as compared to Medicaid managed care plans, and we know that there is a positive association between provider network breadth and premiums . A second potential explanation is that enrollees may perceive the BCBS brand to be of higher quality relative to other brands.…”

Section: Discussionmentioning

confidence: 99%

“…Evidence from the 2017 Marketplaces 14,32 suggests that BCBS plans tend to have broader networks as compared to Medicaid managed care plans, and we know that there is a positive association between provider network breadth and premiums. 33,34 A second potential explanation is that enrollees may perceive the BCBS brand to be of higher quality relative to other brands. It is important to note that systematic differences in the counties and/or states where BCBS insurers operate cannot explain our findings, as we control for all time-invariant county and associated state characteristics in our models.…”

Section: Discussionmentioning

confidence: 99%

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Individual market health plan affordability after cost‐sharing reduction subsidy cuts

Drake

Abraham

2019

Health Services Research

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Objective To investigate how changes in insurer participation and composition as well as state policies affect health plan affordability for individual market enrollees. Data Sources 2014‐2019 Qualified Health Plan Landscape Files augmented with supplementary insurer‐level information. Study Design We measured plan affordability for subsidized enrollees using premium spreads, the difference between the benchmark plan and the lowest cost plan, and premium levels for unsubsidized enrollees. We estimated how premium spreads and levels varied with insurer participation, insurer composition, and state policies using log‐linear models for 15 222 county‐years. Principal Findings Increased insurer participation reduces premium levels, which is beneficial for unsubsidized enrollees. However, it also reduces premium spreads, leading to lower plan affordability for subsidized enrollees. States responding to cost‐sharing reduction subsidy payment cuts by increasing only silver plans' premiums increase premium spreads, particularly when premium increases are restricted to on‐Marketplace silver plans. The latter approach also protects unsubsidized, off‐Marketplace enrollees from experiencing premium shocks. Conclusions Insurer participation and insurer composition affect subsidized and unsubsidized enrollees' health plan affordability in different ways. Decisions by state regulators regarding health plan pricing can significantly affect health plan affordability for each enrollee segment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Individual market health plan affordability after cost‐sharing reduction subsidy cuts

Drake

Abraham

2019

Health Services Research

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“…[1-10] years vs 5 [2][3][4][5][6][7][8][9][10][11] years; P < .001) but did not differ significantly in median (IQR) length of stay (2 [1][2][3] days for both; P = .59).…”

Section: Hospital Encountersmentioning

confidence: 99%

Assessment of Acute Hospital Use and Transfers for Management of Pediatric Seizures

França

McManus

2020

JAMA Netw Open

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IMPORTANCEThe availability of pediatric hospital care for common conditions is decreasing across the US. The consequences of this decrease on access to care for specific conditions need to be evaluated.OBJECTIVE To evaluate the degree of regionalization of pediatric seizure care in the US by characterizing the activity of hospital systems in 6 diverse states. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cross-sectional study used inpatient and emergency department administrative data sets from all acute care hospitals in Arkansas, Florida, Kentucky, Maryland, Massachusetts, and New York from 2014. All patients younger than 18 years who visited a hospital and had a primary diagnosis of seizures were included. Data were analyzed between January and June 2019. MAIN OUTCOMES AND MEASURES Characteristics of hospital encounters and pediatric HospitalCapability Index scores of transferring and admitting hospitals. RESULTS Among 57 930 encounters with pediatric patients with seizures (median [range] age, 4[1-11] years; 31 968 [55.2%] boys) identified in 621 acute care hospitals, 15 467 patients (26.7%) were admitted as inpatients and 3748 patients (6.5%) were transferred between acute care hospitals.Among encounters that resulted in transfers between hospitals, seizure was the only diagnosis in 1554 patients (41.5%). A total of 42 463 encounters began as emergency department visits, of which 38 173 encounters (90.0%) resulted in routine discharge. While 536 hospitals (86.3%) transferred children with seizures, only 232 hospitals (37.4%) ever admitted them and only 63 hospitals (10.1%) ever received a pediatric seizure transfer. The median (interquartile range) pediatric Hospital Capability Index score of all hospitals was 0.10 (0.02-0.28), while that of hospitals occasionally admitting pediatric seizure patients was 0.34 (0.22-0.55). However, although most patients who were admitted had brief stays (ie, Յ2 days) and no comorbidities, three-quarters of all admissions (12 002 admissions [77.6%]) were to very highly capable centers (ie, hospitals with pediatric Hospital Capability Index scores >0.75). Across all states, the number of referral hospitals for pediatric seizures was less than the number of Dartmouth Atlas Hospital Referral Regions (47 referral hospitals vs 63 hospital referral regions). CONCLUSIONS AND RELEVANCEThese findings suggest that although children with seizures are seen in almost all acute care hospital emergency departments, most hospitals transfer children who require admission. Condition-specific interhospital dependency challenges standard definitions of network adequacy and should be accounted for in emergency medical service planning, access to care policies, and health services research.

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“…One of the major criticisms leveled at the Affordable Care Act's insurance marketplaces, and the policies sold on them, is the lack of consumer choice (Dafny, Hendel, Marone, & Ody, ; Haeder, Weimer, & Mukamel, ). A particular focal point of such criticisms has been limitations on the number of in‐network providers for ACA marketplace beneficiaries, a situation labeled as so‐called narrow networks (Haeder, Weimer, & Mukamel, 2015b; Polsky & Weiner, ).…”

Section: Introductionmentioning

confidence: 99%

A Tale of Two Programs: Access to High Quality Providers for Medicare Advantage and Affordable Care Act Beneficiaries in New York State

Haeder¹

2019

World Med & Health Policy

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Medicare Advantage and the Affordable Care Act's insurance marketplaces provide coverage to millions of beneficiaries. This paper assesses network design and access to percutaneous coronary intervention (PCI or angioplasty with stent) in New York for both programs. A specific focus is on access to higher quality providers. The findings indicate that both programs significantly restricted access and choice as compared to an unconstrained network. However, network design only rarely created areas devoid of any providers. In terms of access to quality, both programs tended to have slightly worse mean and median quality ratings than the overall physician supply. Findings with regard to access to above‐average providers were mixed. With respect to access to the highest quality providers, both ACA and Medicare Advantage plans generally fared slightly worse than unrestricted networks. In micropolitan and rural areas, access issues became apparent. Network regulation may do little to address these concerns. However, adding non‐emergency medical transportation benefits to insurance coverage may prove to be desirable going forward.

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Narrow Networks On The Health Insurance Marketplaces: Prevalence, Pricing, And The Cost Of Network Breadth

Cited by 55 publications

References 5 publications

Individual market health plan affordability after cost‐sharing reduction subsidy cuts

Individual market health plan affordability after cost‐sharing reduction subsidy cuts

Assessment of Acute Hospital Use and Transfers for Management of Pediatric Seizures

A Tale of Two Programs: Access to High Quality Providers for Medicare Advantage and Affordable Care Act Beneficiaries in New York State

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