The impact of health plan physician-tiering on access to care

The Impact of Narrow and Tiered Networks on Costs, Access, Quality, and Patient Steering: A Systematic Review

Health insurers use narrow and tiered networks to lower costs by contracting with, or favoring, selected providers. Little is known about the contemporary effects of narrow or tiered networks on key metrics. The purpose of this systematic review was to synthesize the evidence on how narrow and tiered networks impact cost, access, quality, and patient steering. We searched PubMed, MEDLINE, and Cochrane Central Register of Controlled Trials databases for articles published from January 2000 to June 2020. Both narrow and tiered networks are associated with reduced overall health care costs for most cost-related measures. Evidence pertaining to access to care and quality measures were more limited to a narrow set of outcomes or were weak in internal validity, but generally concluded no systematic adverse effects on narrow or tiered networks. Narrow and tiered networks appear to reduce costs without affecting some quality measures. More research on quality outcomes is warranted.

Comparing private and public transport access to diabetic health services across inner, middle, and outer suburbs of Melbourne, Australia

BACKGROUND

Melbourne, Australia is experiencing rapid population growth, with much of this occurring in metropolitan outer suburban areas, also known as urban growth areas. Currently little is known about differences in travel times when using private and public transport to access primary and secondary services across Melbourne's urban growth areas. Plan Melbourne Refresh, a recent strategic land use document has called for a 20 min city, which is where essential services including primary health care, can be accessed within a 20 min journey. Type 2 diabetes mellitus (T2DM) is a major chronic condition in Australia, with some of Melbourne's growth areas having some of the highest prevalence across Australia. This study explores travel times to diabetic health care services for populations residing in inner, middle and outer suburbs of metropolitan Melbourne.

METHOD

Geographic information systems (GIS) software were used to map the location of selected diabetic primary and secondary health care service providers across metropolitan inner, middle, outer established, outer urban growth and outer fringe areas of Melbourne. An origin-destination matrix was used to estimate travel distances from point of origin (using a total of approximately 50,000 synthetic residential addresses) to the closest type of each diabetic health care service provider (destinations) across Melbourne. ArcGIS was used to estimate travel times for private transport and public transport; comparisons were made by area.

RESULTS

Our study indicated increased travel times to diabetic health services for people living in Melbourne's outer growth and outer fringe areas compared with the rest of Melbourne (inner, middle and outer established). Compared with those living in inner city areas, the median time spent travelling to diabetic services was between 2.46 and 23.24 min (private motor vehicle) and 12.01 and 43.15 min (public transport) longer for those living in outer suburban areas. Irrespective of travel mode used, results indicate that those living in inner and middle suburbs of Melbourne have shorter travel times to access diabetic health services, compared with those living in outer areas of Melbourne. Private motor vehicle travel times were approximately 4 to 5 times faster than public transport modes to access diabetic health services in all areas.

CONCLUSION

Those living in new urban growth communities spend considerably more time travelling to access diabetic health services - particularly specialists - than those living in established areas across Melbourne.

The impact of tiered physician networks on patient choices

OBJECTIVE

To assess whether patient choice of physician or health plan was affected by physician tier-rankings.

DATA SOURCES

Administrative claims and enrollment data on 171,581 nonelderly beneficiaries enrolled in Massachusetts Group Insurance Commission health plans that include a tiered physician network and who had an office visit with a tiered physician.

STUDY DESIGN

We estimate the impact of tier-rankings on physician market share within a plan of new patients and on the percent of a physician's patients who switch to other physicians with fixed effects regression models. The effect of tiering on consumer plan choice is estimated using logistic regression and a pre-post study design.

PRINCIPAL FINDINGS

Physicians in the bottom (least-preferred) tier, particularly certain specialist physicians, had lower market share of new patient visits than physicians with higher tier-rankings. Patients whose physician was in the bottom tier were more likely to switch health plans. There was no effect of tier-ranking on patients switching away from physicians whom they have seen previously.

CONCLUSIONS

The effect of tiering appears to be among patients who choose new physicians and at the lower end of the distribution of tiered physicians, rather than moving patients to the "best" performers. These findings suggest strong loyalty of patients to physicians more likely to be considered their personal doctor.