Saturday, July 4, 2015

Quantifying Just How Small The Exchange Networks Are

 This is from the American Journal of Managed Care:
A new study from the University of Pennsylvania’s Leonard Davis Institute (LDI) of Health Economics has shed some light on the breadth of physician networks being sold on the marketplaces. Researchers used a dataset consisting of 450,232 physicians participating in plans issued by 251 carriers across 355 networks. 
This is the first study to summarize network size by physician, not just hospital participation. 
The researchers had to come up with some way to categorize network size, despite the definition by the health law’s legislation leaving some uncertainty. The ACA simply requires that plans maintain “a network that is sufficient in number and types of providers” so that “all services will be accessible without unreasonable delay.” However, what defines sufficiency? 
The LDI report identified 5 network sizes using, admittedly, arbitrary cutoffs: x-small (less than 10% of providers), small (10% to 25% or providers), medium (25% to 40% of providers), large (40% to 60% of providers), and x-large (more than 60% of providers). 
The results of the study found that 41% of networks on the marketplaces are considered small or x-small. Only 11% are considered x-large and include more than 60% of office-based practicing physicians in the area.