Implications of Provider Network Design for Access, Affordability and Competition in Health Insurance

医疗保险提供者网络设计对可及性、可负担性和竞争的影响

• 批准号: 9982268
• 负责人: John A. Graves
• 金额: $ 35.72万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9982268
• 关键词: Implications; Provider; Network; Design; Access

Implications of Provider Network Design for Access, Affordability and Competition in Health Insurance Abstract Insurers have increasingly adopted restricted provider network insurance designs in response to rising health costs and to regulatory mandates on the scope and generosity of private insurance plans. Restricted network plans aim to lower premiums and other plan costs by limiting in-network services to a narrow set of (often low- cost) providers, or through the adoption of tiered networks that encourage use of preferred (lower-cost) facilities and providers. These plan designs have proliferated in recent years: over half of 2015 Affordable Care Act marketplace plans had narrow hospital networks (i.e., fewer than 30% of local hospitals), and one-third of large employer plans had at least one alternative tiered and/or narrow network offering in 2015. While these plan designs have been shown to lower costs, they have also raised concerns over patient access to care and whether such plans compromise affordability of care for patients who wish to maintain their current providers when they switch insurance plans. Research on insurers' provider networks has been quite limited, however, due to well-known inaccuracies and delays in provider network reporting on individual insurers' websites or in plan brochures. This project will overcome these limitations by drawing on novel cleaned and harmonized data on provider networks across a variety of markets (nongroup, employer, Medicare and Medicaid) in all 50 states. We will link these data with a variety of other data sources to execute a project that examines (Aim 1) the relationship between provider network breadth and measures of insurer and provider market concentration and consolidation; (Aim 2) the connectivity of provider networks across insurers and providers within market segments, and across market segments; (Aim 3) the quality and characteristics of in-network providers in narrow and tiered network plans; and (Aim 4) how plan networks adapt to local market changes (i.e., whether plans strategically reshape their provider networks to avoid high-cost patients when a competing plan leaves the market). Our project will inform not only scientific understanding of the role of provider networks in insurance design, access and affordability, but also will provide key insights for policymakers and regulators interested more efficient approaches to provider network oversight.

医疗保险提供者网络设计对可及性、可负担性和竞争的影响 抽象的 保险公司越来越多地采用受限制的提供商网络保险设计，以应对日益增长的健康状况 成本以及对私人保险计划的范围和慷慨的监管要求。网络受限 计划旨在通过将网络内服务限制在一小部分（通常是低保费）来降低保费和其他计划成本。 成本）提供商，或通过采用鼓励使用首选（较低成本）的分层网络 设施和提供者。近年来，这些计划设计激增：2015 年平价医疗计划的一半以上 Act 市场计划的医院网络狭窄（即当地医院不到 30%），并且三分之一 大型雇主计划在 2015 年至少有一种替代的分层和/或窄网络产品。虽然这些 计划设计已被证明可以降低成本，但也引起了对患者获得护理和治疗机会的担忧 此类计划是否会损害希望维持现有医疗服务提供者的患者的护理负担能力 当他们改变保险计划时。然而，对保险公司提供商网络的研究相当有限， 由于各个保险公司网站或网站上的提供商网络报告众所周知的不准确和延迟 计划小册子。该项目将通过利用新颖的、经过清理和协调的数据来克服这些限制 涵盖所有 50 个市场（非团体、雇主、医疗保险和医疗补助）的提供商网络 州。我们将把这些数据与各种其他数据源链接起来，以执行一个检查项目（目标 1） 提供商网络广度与保险公司和提供商市场集中度衡量指标之间的关系 和整合； （目标 2）跨保险公司和市场内提供商的提供商网络的连通性 细分市场以及跨细分市场； （目标 3）网络内提供商的质量和特征 狭窄且分层的网络计划； （目标 4）规划网络如何适应当地市场变化（即，是否 计划战略性地重塑其提供者网络，以避免竞争计划退出时的高费用患者 市场）。我们的项目不仅将有助于科学地理解提供商网络在 保险设计、准入和负担能力，同时也将为政策制定者和监管机构提供重要见解 对更有效的提供商网络监管方法感兴趣。