The cost of health insurance is still a major barrier in the goal of continuing to get more of the remaining uninsured covered, the researchers wrote, even with subsidies available for most marketplace consumers.
That makes narrow networks an important strategy available to insurers to offer lower-cost marketplace plans, and thereby an aid in the success of coverage expansions, the researchers at the University of Pennsylvania concluded.
The study argued the trend toward narrow networks has benefits for both consumers and tax payers, and analysts have previously suggested it shows no signs of slowing as health maintenance organizations (HMOs) and plans with narrow networks have fared better in the exchanges than other types of plans.
More than half of the plans on the exchanges (52%) already are HMOs or narrow network plans, according to a Blue Cross and Blue Shield Association report released earlier this year.
The new Health Affairs research, based on 2014 silver-level plans from all 50 states and Washington D.C., found that a plan with a 6.7% cheaper premium could save an individual $212 to $339 a year and a family of four up to $692 a year.
On the upside, narrow networks allow insurers to better control and monitor patients' care settings and claims to ensure the lowest-cost options are being used. This occurs through the elimination of high-cost providers, lower negotiated reimbursement rates in exchange for steering patient volume, and possibly favorable risk selection as a result of the removal of providers preferred by high-cost beneficiaries, the researchers wrote.
However, they identified potential downsides as well, noting in particular that consumers are often unaware of the restrictions of their plans when they select them. Given the common lack of understanding around plan selection, the researchers argued better communication is needed to help consumers appreciate the value of narrow network plans and better match the plans with consumers who desire that design along with its savings.
Not addressed in the report is the impact of the narrow network trend on health systems and providers, which since the early implementation of the ACA has drawn concern as a potential factor in driving consolidations and closures.