To cut costs, more insurers are offering plans with narrow provider networks and passing along some of the savings to plan members in the form of lower premiums. If the quality of care is not diminished, insurers and members both win, but research suggests that may not be the case.

The New York Times reported on results from three studies pertaining to network size. In one study published by Health Affairs, researchers found that premiums for plans offered in Marketplace exchanges with “extra small” networks (i.e., covering care by less than 10 percent of physicians) were 6.7 percent lower than those for plans with large networks (i.e., covering care by up to 60 percent of physicians). By opting for a plan with a narrow network, an individual could save up to $339 per year.

second study investigated the effect of narrow networks in Massachusetts’ insurance plan for state employees. The results showed that enrollees who switched to a plan with a limited network spent 36 percent less on medical care as compared with enrollees who did not switch. The savings were attributed to lower use of services and lower prices paid per service—for specialists and hospitals, but not for primary care. Moreover, enrollees who switched traveled shorter distances for primary care visits, but not for specialists.

separate study published by Health Affairs involved a “secret shopper” survey of primary care providers (PCPs) listed in plan networks both within and outside the California Marketplace exchange. For the exchange plans (which by nature had narrow networks) only about 30 percent of callers’ attempts to make an appointment with a specific PCP were successful. Callers frequently found that the information in the listing was incorrect, or that the PCP did not accept the caller’s plan or was not accepting new patients. Even when callers said they had acute symptoms, the average wait time for an appointment was about a week and a half.

Leave a comment