41% of silver plans in 'x-small' or 'small' networks and 8 other findings

Consumers have little information to guide their decisions on narrow networks, which have gained popularity under the Patient Protection and Affordable Act to contain costs, according to a report from the Robert Wood Johnson Foundation and the University of Pennsylvania's Leonard Davis Institute of Health Economics.

These plans, which include less than a quarter of area physicians, could be measured in a more meaningful way so consumers can make more informed decisions, according to the report. To examine if this was possible, researchers looked at the 2014 list of 1,065 silver plans sold in the PPACA marketplaces and identified 395 unique provider networks issued by 268 payers. Silver plans are considered the standard plan in the marketplaces, provide an average cost sharing value of 70 percent and can be paired with tax credits and cost sharing reduction subsidies. They used provider directories, the National Provider Identifier and the SK&A physician dataset to analyze the networks.

Based on the findings in the report, researchers suggested insurance networks be categorized into "T-shirt" sizes to make network information more relevant to consumers, regulators and policymakers. Sizes are as follows: x-small (less than 10 percent of area physicians that participate in the network), small (10 percent to 25 percent), medium (25 percent to 40 percent), large (40 percent to 60 percent) and x-large (more than 60 percent).

Here are nine key findings from the report.

  • 41 percent of networks are x-small or small.
  • 48 percent of networks are medium or large.
  • 11 percent of networks are x-large.
  • 37 percent of plans on the marketplace are PPOs.
  • 43 percent are HMOs.
  • 55 percent of HMOs have x-small or small networks.
  • 25 percent of PPOs have x-small or small networks.
  • 36 percent of primary care physician networks are x-small or small.
  • 59 percent of oncology networks are x-small or small.

 

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