Monday, July 20, 2015

Obamacare Exchange Networks Have 34 Percent Fewer Providers Than Commercial Plans Do

Avalere Health has quantified how narrow networks are in Obamacare exchange plans, as shown in the figure below:


According to Avalere CEO President Dan Mendelson: “Plans continue to test new benefit designs in the exchange market. Given the new requirements put in place by the ACA, network design is one way plans can drive value-based care and keep premiums low.” Well, that is one way to look at it and I hope Mr. Mendelson is right.

On the other hand, we have discussed indications that plans are designing plans to attract healthy applicants and shun sick ones. I fear that this research builds on that case, because the networks of specialists (oncologists, cardiologists) are much narrower than the networks of general practitioners.

That is what you would do if you were designing a network for the healthy – ensure adequate access for those who only need their annual preventive visit (free under Obamacare) but reduce access for patients in need of specialty treatment.

I don’t want to go overboard here: It may well be that there are greater differences in quality among specialists than general practitioners, in which case it would be quite reasonable to characterize a very narrow network of specialists as high value.

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