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Narrow networks yield big savings, but a recent study shows they may limit patient access: 5 thoughts

More health insurance companies are offering patients narrow networks to save money, with many studies showing narrow networks do not negatively impact patient access or care. However, a recent study presents different results and raises questions about narrow networks' sustainability, according to The New York Times.

Here are five thoughts:

1. Philadelphia-based Leonard Davis Institute of Health Economics researchers found of the plans offered on the Affordable Care Act marketplaces, very narrow networks (constituting plans that cover care by less than 10 percent of physicians) charge 6.7 percent lower premiums than plans with much broader networks. Broader networks encompass plans that cover care by up to 60 percent of physicians.

2. Despite these savings, many were worried narrow networks may impede quality patient care, but a 2012 Massachusetts Group Insurance Commission study alleviated many of these concerns. The commission offered government employees the opportunity to waive three months of employee premium contributions if they enrolled in new, narrow network plans, which yielded $500 in savings per enrollee, on average. However, the new plan covered about half as many physicians and 33 percent fewer hospitals than the previous plans.

3. The Massachusetts Group Insurance Commission offered the plan to nearly 100,000 state employees and their dependents, but did not offer the plans to nearly 20,000 enrollees who are state municipality employees for comparison purposes. The researchers found those who changed plans spent 36 percent less on healthcare and narrow network enrollees used emergency departments less. Researchers found no evidence indicating patients in narrow network plans used lower quality hospitals.

4. A notable study finding revealed the savings were concentrated amongst enrollees who kept their primary care physician even after switching to the narrow network plan. The study also found patients traveled less for primary care visits. NYT notes this finding falls in line with narrow network's aim to increase access to primary care specialist, as opposed to "costly specialists."

5. However, a recent study analyzing plans offered in California found patient access to primary care physicians was relatively poor for certain plans offered through the state's ACA marketplace last year. The majority of ACA plans in the state, like many other states, are narrow network plans. Researchers employed a "secret shopper" approach and found:  
•    Nearly 30 percent of attempts to make appointments with specific primary care physicians reaped success.
•    In 15 percent of cases, the physician did not accept the shopper's plan, even though the physician was listed in the patient's directory.
•    The directory included the wrong phone number or the number was busy in two calls on consecutive days in almost 20 percent of cases.
•    Ten percent of the physicians called were not accepting new patients.
•    Almost 30 percent of the physicians called were not primary care physicians, although the directory listed them as such.
•    When the caller said they have acute symptoms, the average weight time for an appointment totaled one and a half weeks.

More articles on coding & billing:
Physicians react to CMS' final MACRA rule — 6 things to know
The judge has spoken: Anthem, Cigna required to disclose accusatory emails — 5 thoughts
After receiving 'overweight' rating Anthem shares drop 2%: 3 thoughts

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