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: 10229340
• 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 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10229340
• 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.

提供者网络设计对健康保险的可及性、可负担性和竞争的影响 摘要 保险公司越来越多地采用限制性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（通常是低- 成本）提供商，或通过采用分层网络，鼓励使用首选（低成本） 设施和供应商。这些计划设计近年来激增：2015年平价医疗的一半以上 法案市场计划有狭窄的医院网络（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/或窄网络产品。虽然这些 计划设计已被证明可以降低成本，它们也引起了对患者获得护理的担忧， 这些计划是否会损害希望维持现有提供者的患者的医疗负担能力 当他们改变保险计划。然而，对保险公司提供商网络的研究相当有限， 由于个别保险公司网站上的供应商网络报告或 计划手册。该项目将通过利用新的清洁和协调的数据来克服这些限制 在所有50个市场（非团体、雇主、医疗保险和医疗补助）的提供商网络上， states.我们将把这些数据与其他各种数据源链接起来，以执行一个项目， 供应商网络广度与保险公司和供应商市场集中度关系 （目标2）市场内保险公司和供应商之间的供应商网络连接 （目标3）网络内供应商的质量和特点， 狭窄且分层的网络计划;以及（目标4）计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，以避免在竞争计划退出时出现高成本患者 市场）。我们的项目不仅将为科学理解提供商网络在 保险设计、可获得性和可负担性，还将为政策制定者和监管机构提供关键见解 更有效的方法来监督供应商网络。

项目成果

Geographic Variation in Hospital-Based Physician Participation in Insurance Networks.

• DOI: 10.1001/jamanetworkopen.2022.15414
• 发表时间: 2022-05-02
• 期刊: JAMA NETWORK OPEN
• 影响因子: 13.8
• 作者: Nikpay, Sayeh;Nshuti, Leonce;Richards, Michael;Buntin, Melinda B.;Polsky, Daniel;Graves, John A.
• 通讯作者: Graves, John A.

Physician patient sharing relationships within insurance plan networks.

医生患者在保险计划网络内共享关系。

• DOI: 10.1111/1475-6773.14138
• 发表时间: 2023
• 期刊: Health services research
• 影响因子: 3.4
• 作者: Graves,JohnA;Lee,Dennis;Leszinsky,Lena;Nshuti,Leonce;Nikpay,Sayeh;Richards,Michael;Buntin,MelindaB;Polsky,Daniel
• 通讯作者: Polsky,Daniel

Provider networks and health plan premium variation.

提供商网络和健康计划保费变化。

• DOI: 10.1111/1475-6773.13447
• 发表时间: 2021
• 期刊: Health services research
• 影响因子: 3.4
• 作者: Polsky,Daniel;Wu,Bingxiao
• 通讯作者: Wu,Bingxiao

Breadth and Exclusivity of Hospital and Physician Networks in US Insurance Markets.

美国保险市场中医院和医师网络的广度和排他性。

• DOI: 10.1001/jamanetworkopen.2020.29419
• 发表时间: 2020-12-01
• 期刊: JAMA network open
• 影响因子: 13.8
• 作者: Graves JA;Nshuti L;Everson J;Richards M;Buntin M;Nikpay S;Zhou Z;Polsky D
• 通讯作者: Polsky D

Access to In-Network Hospitals in Tennessee During the COVID-19 Pandemic.

• DOI: 10.1001/jamahealthforum.2022.0063
• 发表时间: 2022-03
• 期刊: JAMA health forum
• 作者: Graves JA;Baig K;Buntin M
• 通讯作者: Buntin M