Exploring Network Transparency Part II
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.
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.
There are three network breadth ratings:
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.
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?
Our analysis of FFM network data revealed similar results to those of the four test pilot states.
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.
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?
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.
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.
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.
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