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Consumers Prioritize Broad Networks, Keeping Current Provider – HealthPayerIntelligence.com

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By Kelsey Waddill

– Consumers are willing to pay more for broader provider networks and many, including women, also place high priority on maintaining coverage for providers to whom they are already connected when choosing a new health plan, a survey published in the American Journal of Managed Care discovered.

In an effort to lower costs, some experts—including some payers—have suggested that health plans adopt smaller network sizes that are more constricted.

But, the researchers stated, while data shows that plans with smaller networks on the Affordable Care Act marketplaces boast premiums that are 6 to 13 percent less expensive than larger networks, opponents of this strategy argue that it restricts member access to specialty care providers.

Furthermore, member education about how to find the right provider network may be stunted. Network adequacy is just as problematic as network size, but consumers may struggle navigating the system to discern which providers they need to have in-network. Other obstacles, such inaccurate provider directories, complicate the endeavor even more.

The researchers surveyed 992 patients through a third-party vendor. The survey presented consumers with hypothetical plans that differed in five ways, while all other aspects matched:

  • Network breadth
  • Travel time to closest in-network, primary care services provider
  • Full or partial coverage of primary care services provider
  • Wait time to schedule an appointment
  • Monthly premium amount

The survey discovered that provider network breadth was a priority for potential members. Consumers would pay a $72 premium for a plan that had a 30 percent larger network.

Keeping a personal provider was also high priority for respondents. They were willing to pay about the same to keep their own provider as they were to have a network that was 39 percent broader.

Members were willing to pay a $95 premium to keep their personal provider. Specifically, women were more likely to pick a plan that offered coverage for their personal provider.

In contrast, potential members would pay $45 premiums for a wait time that was shorter by three days. They would pay a $5 premium for a shorter travel time to their provider.

Respondents were willing to forego keeping their personal provider if another plan would give them access to a broad network.

Based on the data, the researchers also argued that sicker patients would be more interested in a broader network of providers than their healthy counterparts.

“An environment with narrow networks and extensive exclusive networks could be problematic; individuals would be restricted to either their current plan and doctor or alternative plans without either a broad network or their doctor,” the researchers warned.

“This could create market power for health plans. However, this market power could be mitigated by the option of broad network alternatives.”

Meanwhile wait time, travel time, and premium all were reasons for a potential member not to choose certain plans. Income and wait time were fairly aligned, with higher income individuals caring more about whether they had long wait times.

“The results of this study imply that providing more information about whether enrollees can stay with their current primary care doctor and making it easier to compare plans based on the ‘doctor finder’ would add value to patients,” the researchers concluded.

The results also underscored the importance of having coverage for providers last an entire year.

Medicaid payers now hold a substantial market share on the Affordable Care Act marketplaces in part because they tend to have smaller networks. These smaller networks keep administrative costs low as payers have less paperwork to handle.

However, broader networks have proven more attractive to seriously ill patients who tend to look for less restrictive policies and a variety of provider options.



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