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

医疗保险提供商网络设计对获取、可负担性和竞争的影响 摘要 保险公司越来越多地采用受限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范围和慷慨程度的监管要求。受限网络 计划旨在通过将网络内服务限制在一组狭窄的(通常较低的)网络内服务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(低成本)的分层网络 设施和供应商。近年来，这些计划设计激增：2015年负担得起的医疗保健的一半以上 ACT市场计划的医院网络很窄(即不到30%的当地医院)，三分之一的 2015年，大型雇主计划至少有一个替代分层和/或狭窄网络服务。而这些 计划设计已被证明降低了成本，它们也引起了对患者获得护理和 这样的计划是否会影响希望维持现有提供者的患者的护理负担能力 当他们更换保险计划时。然而，对保险公司提供商网络的研究一直相当有限， 由于个别保险公司网站上的提供商网络报告或 平面图小册子。该项目将通过利用新的、干净和协调的数据来克服这些限制 在所有50个市场(非集团、雇主、联邦医疗保险和医疗补助)的提供商网络上 各州。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的关系 和整合；(目标2)市场内保险公司和供应商之间的供应商网络连接 细分市场；(目标3)#年网络内供应商的质量和特点 狭窄和分层的网络计划；以及(目标4)计划网络如何适应当地市场的变化(即，是否 计划战略性地重塑其提供商网络，以避免在竞争计划离开时出现高成本患者 市场)。我们的项目不仅将使人们对提供商网络在 保险设计、可获得性和可负担性，但也将为政策制定者和监管机构提供关键见解 对提供商网络监督的更有效方法感兴趣。

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.