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Posted by on Feb 27, 2017 in Uncategorized | 0 comments

Exploring Network Transparency Part II

Exploring Network Transparency Part II

Introduction

Click here to download the Issue Brief, Exploring Network Transparency Part II (PDF).

In April of 2016, we took an in-depth look at the Centers for Medicare & Medicaid Services (CMS) rule about adding “network breadth” ratings to Healthcare.gov in our blog post, Exploring Network Transparency.

By 2017 Open Enrollment, CMS settled on publishing the network breadth ratings in four test pilot states: Maine, Ohio, Tennessee, and Texas. As a follow-up to our preliminary analysis, we took a deep dive into what the ratings look like in the test pilot states.

What We Did

2017 exchange network data for all networks in Maine, Ohio, Tennessee, and Texas was collected, cleaned, standardized, matched, and individualized. A sample of network data in other Federally-Facilitated Marketplace states (FFMs) also underwent this multi-step processing.

The data was then analyzed and the Provider Participation Rates, or PPRs, for each network were calculated based on guidelines published by CMS (see Sources on page 7 of the Issue Brief for more details). We sought clarification from CMS where we had questions about their methodology; this additional information influenced our final methodology.

The network classification ratings published on Healthcare.gov were collected for plans available in Ohio and Texas. This data was cleaned and matched to the plan and network data available in the CMS Health Insurance Marketplace Public Use Files (Marketplace PUFs). For examples of how the ratings are displayed on Healthcare.gov, see the Appendix of the Issue Brief.

Why We Did This

Our goal is to ensure our clients have visibility into how their provider data is being viewed in the market. By monitoring the network landscape, we are able to alert issuers to situations where they are at a disadvantage. We give our clients the information and tools they need to adapt quickly to the changing healthcare landscape.

background

For the 2017 Open Enrollment period, network breadth ratings were made available to consumers on Healthcare.gov during the plan selection process.

The ratings are a measurement of network strength based on provider counts.

  • Each network’s breadth is compared to the network breadth of other QHPs available in the same county.
  • The ratings focus on hospitals, adult primary care, and pediatric primary care.
  • The ratings are determined by calculating the Provider Participation Rate (PPR) or the number of providers available in a network divided by the total number of providers available in all exchange plans in the county.

Network Classifications

There are three network breadth ratings:

  • Smaller than other plans (Basic)
  • About the same as other plans (Standard)
  • Larger than other plans (Broad)

 

Key Findings

Provider Type

Among the provider types included in this analysis in the four test pilot states, the hospital portion of networks was the broadest overall.

The average percent of providers participating in hospital networks (67.3%) was higher than that of adult primary care providers (45.6%) and pediatric primary care providers (45.8%) in the four test pilot states.

CBSA Regions

In Rural and CEAC areas, issuers have fewer provider options to choose from to build their networks; this often means issuers must contract with all providers in these regions to build adequate networks. Networks in these areas often have higher rates of provider participation.

On the other hand, issuers have multiple providers to choose from in Large Metro and Metro areas so they can narrow their networks and they will remain adequate. These areas often have lower rates of provider participation.

We see this reflected in the results of our analysis. CEAC counties tend to include the greatest percentage of available providers in-network while Large Metro counties tend to include the fewest available providers.

Why does Maine have the broadest networks?

Competition
Maine has more competition in each county than in the other test pilot states. There are no counties in Maine where only one or two issuers are offering plans; while the other states have many counties where this is the case.

Geography
Networks with fewer participating providers, or narrow networks, tend to be most common in Large Metro areas. There are NO large metro counties in Maine.

Federally-Facilitated States

Our analysis of FFM network data revealed similar results to those of the four test pilot states.

Provider Type

Among the provider types included in this analysis, the hospital portion of networks was the broadest overall.

The average percent of providers participating in hospital networks (88.4%) was higher than adult primary care providers (44.2%) and pediatric primary care providers (51.9%) in the FFM states.

Plan Type

Looking at plan type, we found networks utilizing plans labeled as PPO had the highest average PPR (64.4%), followed by POS (62.1%), HMO (59.1%) and EPO (52.3%) labeled plans.

How do the four test pilot states compare to the other FFM states?

Provider Type
When comparing the test pilot states to the sample FFM states, the biggest difference in average network breadth is in the size of the hospital networks. In the test pilot states, the average hospital PPR is 67.3% compared to 88.4% in the sample FFM states.

CBSA Regions
Again, we see that CEAC counties tend to include the greatest percentage of available providers in-network while Large Metro counties tend to include the fewest available providers, with the exception of EPO plans.

Heathcare.gov Ratings

Ratings

Overall, in Ohio and Texas, 3.4 percent of networks were rated as broad, 62.5 percent were rated as standard, and 34.2 percent were rated as basic.

Ohio vs Texas

Basic networks were more common in Ohio than in Texas, while standard networks were more common in Texas than Ohio.

 

Comparing States

State exchange markets are unique. There can be large differences in the breadth of networks between states. Ohio and Texas are a great example of the variations we can see.

CBSA Regions

Across all CBSA regions, in Ohio and Texas, standard networks were most common, followed by basic and then broad networks.

Large Metro and Metro regions had the greatest percent of networks that were broad.

CEAC and Rural regions had the greatest percent of networks that were standard.

Micro regions had the greatest percent of networks that were basic.

Healthcare.gov Ratings

Plan-to-network ratings
The ratings on Healthcare.gov are displayed at the plan level. Our Insights team matched those plans to the network data available in the CMS Health Insurance Marketplace Public Use Files (Marketplace PUFs) in order to show ratings at the issuer-network level.

Interested in your own custom market analysis?

Contact Strenuus Insights at, insights@strenuus.com.

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