Most top-ranked hospitals in at least one ACA exchange network

Nearly all highly ranked regional hospitals are in at least one Affordable Care Act marketplace plan network, yet hospitals' network participation still "declined significantly" in 2016, a new analysis from the Robert Wood Johnson Foundation (RWJF) shows.

To assess how networks are changing on the ACA exchanges, the analysis compares providers accessible through marketplace plans with U.S. News & World Report's list of Best Regional Hospitals. It found that 97 percent of these ranked hospitals were in-network with at least one marketplace plan in 2015, and 96 percent were in 2016.

"I think it shows there's a lot of choice still in terms of hospitals that people would want to go to," Kathy Hempstead (right), who leads RWJF's work on health insurance coverage, tells FierceHealthPayer in an exclusive interview. "It shows that there's still pretty broad-based access to these high-quality hospitals in most markets."

But the findings aren't all positive. In 2016, only 43 percent of these hospitals either maintained or increased the number of marketplace networks in which they participated, and 57 percent participated in fewer networks. Nationwide, 20 percent fewer marketplace networks included a regionally ranked hospital.

The results also varied by geography, with rural and smaller states seeing fewer declines in network participation among regionally ranked hospitals. The analysis also found that these hospitals may be more likely to exit marketplace plans in urbanized states and in more urban parts of states.

Hempstead sees the trend of narrowing marketplace networks as "the beginning of a course correction" for health plans as they adjust to operating on the exchanges. Previous RWJF research conducted by Hempstead also found there are fewer plans on the exchanges that offer out-of-network benefits, as two-thirds of insurers that offered preferred provider organization plans last year on the ACA exchanges have either reduced or stopped offering them in 2016.

However, it may be too soon to tell whether such trends will continue in subsequent years.

"In some ways that will depend on what the experience is this year [for insurers]," Hempstead says, though she adds that she would be surprised if insurers lose as much money on the exchanges this year as they did in 2015, as many have taken steps to stem their financial losses.

To learn more:
- here's the analysis

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