Physician patient sharing relationships within insurance plan networks.
Physician patient sharing relationships within insurance plan networks.
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医生患者在保险计划网络内共享关系。
DOI：
10.1111/1475-6773.14138
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发表时间：
2023
影响因子：
3.4
通讯作者：
Polsky,Daniel
中科院分区：
文献类型：
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作者：
Graves,JohnA;Lee,Dennis;Leszinsky,Lena;Nshuti,Leonce;Nikpay,Sayeh;Richards,Michael;Buntin,MelindaB;Polsky,Daniel
目的量化初级保健医生 (PCP) 与心脏病专家和肿瘤专家之间共享的患者关系，以及这些关系在保险网络中捕获的程度。数据源对医生网络上的 Vericred 数据、医生共享的 Medicare 患者的 CareSet 数据以及来自 Health Insurance Compare 的保险计划属性进行二次分析。数据验证练习使用来自 Physician Compare 和 IQVIA 的数据。研究设计 PCP 与专科医生网络内共享患者百分比的横断面研究（主要结果）。我们还按保险细分市场（Medicare Advantage [MA]、医疗补助管理式医疗、小团体或个人购买）、保险计划类型和网络广度对网络进行分类。数据提取我们分析了 219,982 名 PCP、29,400 名心脏病专家和 22,745 名肿瘤科医生的数据，他们在 2021 年接受了 MA（n= 941 个网络）、医疗补助管理式医疗（n= 293）和个人购买 (n= 332) 和小组 (n= 501) 计划。主要发现网络平均捕获了 64.6% 的 PCP 心脏病学共享患者关系和 61.8% 的 PCP 肿瘤学家共享关系。不到一半的网络内关系（分别为 44.5% 和 38.9%）是具有共同组织关系的医生。对网络广度进行调整后，我们没有发现任何证据表明保险细分市场或不同类型网络之间的共享患者百分比存在差异（所有比较的 p 值 >0.05）。国家网络与地方和区域网络之间存在一个例外，我们发现国家计划捕获的共享患者联系较少，特别是在最狭窄的网络中（PCP-心脏病学国家网络为 58.4%，地方和区域网络为 64.7%）。结论鉴于最近网络缩小的趋势，我们的研究结果强调了纳入网络构成的额外和细致入微的措施的重要性，以帮助（针对患者）选择计划并指导监管监督。
ObjectiveTo quantify shared patient relationships between primary care physicians (PCPs) and cardiologists and oncologists and the degree to which those relationships were captured within insurance networks.Data SourcesSecondary analysis of Vericred data on physician networks, CareSet data on physicians' shared Medicare patients, and insurance plan attributes from Health Insurance Compare. Data validation exercises used data from Physician Compare and IQVIA.Study DesignCross‐sectional study of the PCP‐to‐specialist in‐network shared patient percentage (primary outcome). We also categorized networks by insurance market segment (Medicare Advantage [MA], Medicaid managed care, small‐group or individually purchased), insurance plan type, and network breadth.Data ExtractionWe analyzed data on 219,982 PCPs, 29,400 cardiologists, and 22,745 oncologists who, in 2021, accepted MA (n= 941 networks), Medicaid managed care (n= 293), and individually‐purchased (n= 332) and small‐group (n= 501) plans.Principal FindingsNetworks captured, on average, 64.6% of PCP‐cardiology shared patient ties, and 61.8% of PCP‐oncologist ties. Less than half of in‐network ties (44.5% and 38.9%, respectively) were among physicians with a common organizational affiliation. After adjustment for network breadth, we found no evidence of differences in the shared patient percentage across insurance market segments or networks of different types (p‐value >0.05 for all comparisons). An exception was among national versus local and regional networks, where we found that national plans captured fewer shared patient ties, particularly among the narrowest networks (58.4% for national networksvs. 64.7% for local and regional networks for PCP‐cardiology).ConclusionsGiven recent trends toward narrower networks, our findings underscore the importance of incorporating additional and nuanced measures of network composition to aid plan selection (for patients) and to guide regulatory oversight.