Quality Advantage? Provider Quality and Networks in Medicare Advantage

Abstract

Medicare Advantage plans have grown significantly over the past decade and the potential for their future growth seems unabated. Astonishingly, however, we know little about how Medicare beneficiaries access services, particularly whether those services are of high quality. This study explores access to cardiac surgeons for coronary artery bypass grafting (CABG) and heart valve surgery in California and New York. It is one of the first studies to analyze Medicare Advantage networks and interactions between provider networks and provider quality. Results of the study show that for large metropolitan areas, access is rather similar for traditional Medicare and Medicare Advantage beneficiaries. Limitations, however, exist for the latter. Important concerns emerge for Medicare Advantage beneficiaries outside of metropolitan areas where healthcare market challenges appear to be exacerbated by carrier restrictions. Results indicate no evidence that carriers selectively contract to improve quality. There is, however, significant diversity with regard to network breadth; and, this breadth does not stay static across distances. These results hold important implications for the future of the Medicare program, network adequacy regulations, and how consumers make choices about their insurance coverage.

Regional variation in healthcare usage for Medicare beneficiaries: a cross-sectional study based on the health and retirement study

“… 18–20 Compared with Medicare beneficiaries with supplemental health insurance, Medicare-only beneficiaries are confronted with restrictions as an important barrier in healthcare access. 17 21 Other barriers to access like lack of transportation may further restrict access to healthcare for certain Medicare beneficiaries. 10 New England and Mid-Atlantic regions have better public transportations than other regions.…”

“…One potential explanation may be that narrow provider networks restricted access to care for Medicare beneficiaries 17–19. Compared with New England and Mid-Atlantic regions, Medicare plans in other regions may not provide large enough provider networks 18–20.…”

“…One potential explanation may be that narrow provider networks restricted access to care for Medicare beneficiaries. [17][18][19] Compared with New England and Mid-Atlantic regions, Medicare plans in other regions may not provide large enough provider networks. [18][19][20] Compared with Medicare beneficiaries with supplemental health insurance, Medicare-only beneficiaries are confronted with restrictions as an important barrier in healthcare access.…”

Potemkin Protections: Assessing Provider Directory Accuracy and Timely Access for Four Specialties in California

“…Regulators can rely on single standards or hybridized approaches. However, a growing literature has raised significant questions about the selection and effectiveness network adequacy standards of all categories (Murrin 2014;Haeder, Weimer, and Mukamel 2019b;Brodsky, Smith, and Rodin 2015;Haeder 2020bHaeder , 2020aHaeder, Weimer, and Mukamel 2021).…”

Going the Extra Mile? How Provider Network Design Increases Consumer Travel Distance, Particularly for Rural Consumers

“…Recent scholarly attention on provider networks has largely focused on their effects on premiums (Dafny et al 2017;Polsky, Cidav, and Swanson 2016) as well as on their narrowness (Giovannelli, Lucia, and Corlette 2015;Mukamel 2015a, 2015b;Polsky and Weiner 2015). Several studies have even begun to explore the relationship between provider quality and network design (Haeder, Weimer, and Mukamel 2015a;Haeder , 2019cHaeder , 2020Yasaitis, Bekelman, and Polsky 2017). While premiums and the number of in-network providers are important to consumers, insurers can impose another potentially challenging barrier to consumer access through decisions about which providers to include in their networks.…”