Four in 10 silver plans (41%) sold on the insurance exchanges in 2014 had narrow networks, in which fewer than 25 percent of physicians in the area are covered, according to findings from researchers at the University of Pennsylvania’s Leonard Davis Institute of Health Economics, funded by the Robert Wood Johnson Foundation. Previous analyses of marketplace plans left an incomplete picture by showing only the number of hospitals covered. The research released today is the first to include data on individual physicians.
In total, 11 percent of silver plans sold in the marketplaces are considered “extra small”—meaning they cover fewer than 10 percent of physicians in the plan region. Another 30 percent are “small”—covering between 10 and 25 percent of the area’s physicians. The brief shows that health maintenance organizations, or HMOs, are more likely to have small physician networks compared to preferred provider organizations, or PPOs. The researchers also show that networks vary when sized by physician specialty: in primary care, 36% of networks are considered small or x-small, compared to 23% for internal medicine subspecialties, and 59% for oncology.
The authors note several implications to their findings. They suggest that in addition to efforts to raise awareness of plan quality and costs, marketplaces should take similar steps to inform consumers of the scope of the physician network of each plan. Allowing consumers to quickly ascertain if a physician they trust is covered under a specific plan, as well as easy-to-understand, “t-shirt size” network ratings (e.g., x-small, small, medium, large) are just two practices they suggest.
“Provider network size and composition has become an important part of how insurers price marketplace plans and attract consumers, but so far, consumers do not have usable information about provider networks,” said Kathy Hempstead, who directs coverage issues at the Robert Wood Johnson Foundation. “Consumers need to be able to see the forest as well as the trees when they make a plan choice and these data are a first step in giving them the full picture of which physicians are covered under specific plans.”
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