Primary care appointment availability for new Medicaid patients declined when Medicaid fees for providers decreased after the ACA-mandated “fee bump” expired.
The prevalence of narrow provider networks on the ACA Marketplace is trending down. In 2017, 21% of plans had narrow networks, down from 25% in 2016. The largest single factor was that 70% of plans from National carriers exited the market and these plans had narrower networks than returning plans. Exits account for more than half of the decline in the prevalence of narrow networks, with the rest attributed to broadening networks among stable plans, particularly among Blues carriers. The narrow network strategy is expanding among traditional Medicaid carriers and remains steady among provider-based carriers and regional/local carriers.
This Issue Brief describes the breadth of physician networks on the ACA marketplaces in 2017. We find that the overall rate of narrow networks is 21%, which is a decline since 2014 (31%) and 2016 (25%). Narrow networks are concentrated in plans sold on state-based marketplaces, at 42%, compared to 10% of plans on federally-facilitated marketplaces. Issuers that have traditionally offered Medicaid coverage have the highest prevalence of narrow network plans at 36%, with regional/local plans and provider-based plans close behind at 27% and 30%. We also find large differences in narrow networks by state and by plan type.
Subsidized reinsurance represents a potentially important tool to help stabilize individual health insurance markets. This brief describes alternative forms of subsidized reinsurance and the mechanisms by which they spread risk and reduce premiums. It summarizes specific state initiatives and Congressional proposals that include subsidized reinsurance. It compares approaches to each other and to more direct subsidies of individual market enrollment. For a given amount of funding, a particular program’s efficacy will depend on how it affects insurers’ risk and the risk margins built into premiums, incentives for selecting or avoiding risks, incentives for coordinating and managing care, and the costs and complexity of administration. These effects warrant careful consideration by policymakers as they consider measures to achieve stability in the individual market in the long term.
In 2016, ACA marketplace plans offered provider networks that were far narrower for mental health care than for primary care. On average, plan networks included 24 percent of all primary care providers and 11 percent of all mental health care providers in a given market. Just 43 percent of psychiatrists and 19 percent of nonphysician mental health providers participate in any network. These findings raise important questions about network sufficiency, consumer choice, and access to mental health care in marketplace plans.
Community Health Worker Support For Disadvantaged Patients With Multiple Chronic Diseases: A Randomized Clinical Trial
Community health worker interventions hold promise for improving outcomes of low-income patients with multiple chronic diseases.
These proceedings summarize the insights shared by nationally renowned panels of experts and overall themes discussed throughout the conference. The conference included experts from academia and public and private sectors, who came together to discuss the gaps in evidence-based substance use policy and practice, with particular emphasis on the opioid epidemic. The conference concluded with an interactive session focused on the exchange of ideas and solutions to curb the opioid epidemic. Those ideas are included here.
Structural, Nursing, and Physician Characteristics and 30-Day Mortality for Patients Undergoing Cardiac Surgery in Pennsylvania
This study finds no relationship between mortality and cardiac ICU organizational factors, such as presence of daytime or nighttime intensivists, nurse ICU experience, or presence of interns or residents.
This study finds that narrower provider networks offered on the health insurance exchanges are more likely to exclude oncologists associated with high-quality National Cancer Institute (NCI)-Designated Cancer Centers.
This Issue Brief reviews the current status and characteristics of PDMPs, their use, and evidence of their effectiveness. It summarizes best practices for PDMPs and the needs for further research and evaluation.
Effect of a Price Transparency Intervention in the Electronic Health Record on Clinician Ordering of Inpatient Laboratory Tests
In this randomized clinical trial, clinicians did not change their ordering of inpatient lab tests when Medicare allowable fees were displayed in the electronic health record at the time of order entry.
This study finds that automated methods for analyzing physician notes within electronic health records can identify social risk factors more completely than administrative data, enhancing a hospital’s ability to identify patients at risk of readmission.
Implementation of the laborist model was associated with a 15% decrease in the odds of the induction of labor and a 17% decrease in the odds of preterm birth.
A diverse set of national leaders and stakeholders representing industry, think-tanks, provider and patient groups, and academic experts discussed how health systems, payers, and providers can spur the ‘de-adoption’ of medical practices and technologies no longer considered valuable.
In a review of ACA plans, the authors find that the proportion of narrow networks were greater for pediatric specialties than for adult specialties, highlighting the need to monitor access to specialty care for children and families.