Association for Public Policy Analysis & Management

Panel: Narrow Network Health Insurance Plans: Enrollee Experiences and Insurer Strategy

(Health Policy)

Narrow provider networks are mechanisms frequently implemented by health plans. In a narrow provider network, health plans exclude providers from their covered networks to reduce health care costs. Narrow networks are widely used by health plans in the Health Insurance Marketplaces established by the Affordable Care Act, and are increasingly being implemented by private employment-based health plans. Current literature shows that narrow networks reduce health care costs; however, other aspects of narrow networks have been less studied. In this session, we examine several dimensions of narrow provider networks: consumers’ satisfaction and valuation of narrow networks, network quality in narrow networks, and insurers’ incentives for offering narrow network plans.

The first paper explores Medicaid and Marketplace enrollees’ satisfaction with their plans using the 2016 Commonwealth Fund Affordable Care Act Tracking survey. Specifically, they examine enrollees’ overall satisfaction, change in access to care, access to desired providers, appointment times, and the importance of network size in place choice. Updated 2017 data will be available for the Fall Research Conference.

The second paper uses data from a private health insurance exchange offered in the context of employment-based insurance to quantify consumers’ valuation of provider continuity. The data allow the authors to separately assess the value of continuity in primary care and specialty care relationships, to examine how these values change with the consumer's health status, and to assess the value of network breadth in general.

The third paper uses 2016 healthcare.gov network databases assembled by the Centers for Consumer Information and Insurance Oversight (CCIIO) to review the association between network breadth and the quality and characteristics of hospitals offered in Health Insurance Marketplace plans. The authors compiled provider network information on 96 percent of all silver Marketplace plans, and matched it with hospital information from the American Hospital Association in order to assess the differences among Marketplace plans’ hospital networks.

Finally, the fourth paper reviews 2017 CCIIO network data from 37 states to test whether the proliferation of narrow network Marketplace plans  is a result of consumers preferring narrow network plans or insurers’ attempting to avoid costly, sicker patients by offering narrow networks (i.e., adverse selection). Identifying which of these is occurring is necessary for identifying appropriate policy solutions.