Study raises concerns about Medicaid managed care's narrow networks
Medicaid managed care plans’ narrow networks experience higher physician turnover than other plans, which could pose problems for patient care, according to a recent Health Affairs report.
In a review of managed care plans with narrow networks in 14 states, the researchers found that narrow networks had a three percentage point higher turnover rate in one year and 20 percentage point higher rate after five years compared to non-narrow network plans.
The report said state regulators must monitor health plans’ provider networks to make sure there isn't too much doctor turnover that it causes issues with physician continuity.
Many payers have turned to narrow networks as a way to contain health costs, improve quality and influence physician behavior. Narrow networks are common in Medicaid managed care, Medicare Advantage (MA) and Affordable Care Act (ACA) plans, though not in employer-sponsored health insurance yet.
However, critics worry that narrow networks can restrict access to care and choice — and cause patients to lose trusted physicians. That can create a roadblock to positive health outcomes.
The Health Affairs analysis looked into whether narrow primary care physician networks in Medicaid managed care are connected to lower rates of physician continuity. The researchers explored the period between 2010 and 2015 and considered narrow plans ones that employed 30% or less of primary care physicians in their market.
The report found 80% of Medicaid beneficiaries are in managed care plans and many of those people are clinically or socially vulnerable with complicated healthcare needs. Healthcare disruptions like losing a primary care physician can cause healthcare problems, but that disruption “might not be detected by existing measures that evaluate network breadth,” the report said.
State and federal investigators have raised other concerns about physician networks in MA and ACA plans. The Washington Office of the Insurance Commissioner fined Centene’s Coordinated Care $1.5 million in December because of issues with its provider network.
CMS wants more oversight over MA payers’ provider networks, so insurers will give current and accurate information about providers.
- Health Affairs Network Optimization And The Continuity Of Physicians In Medicaid Managed Care
- Healthcare Dive Could narrow networks be the next big cost cutter?