Study takes stock of MA hospital networks

hospital sign

The average Medicare Advantage plan network includes about half of the hospitals in its county, according to a new analysis from the Robert Wood Johnson Foundation.

The analysis, according to the RWJF, is the first broad-based assessment of how provider networks are structured in Medicare Advantage.

MA provider network adequacy is an issue of crucial importance since many Medicare beneficiaries say access to certain providers is a top priority to them, the report notes, and since a recent Government Accountability Office report flagged serious deficiencies in the oversight and enforcement of MA network requirements.

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The analysis found that 23 percent of MA plans studied had broad hospital networks in 2015, while 16 percent had narrow or ultra-narrow networks. In In 9 of the 20 counties studied, none of the MA plans available in 2015 had a broad network of hospitals within that county.

Eighty percent of plans had an academic medical center in their network, though 2 in 5 plans that had a National Cancer Institute-designated cancer center in their area didn’t include that facility in their networks.

The majority of plans included in the study were HMOs rather than PPOs. Of those, broad- and narrow-network plans had similar average premiums of $37 and $36 per month, respectively, and similar quality ratings of 3.8 and 4.1 stars.

Though the study didn’t explicitly examine provider listing accuracy, researchers also discovered “a number of issues related to the accuracy and reliability of provider directories,” the report says.

Overall, the researchers write, their findings “underscore the importance of comparing provider networks during the Annual Election Period--a task that is easier said than done” for MA beneficiaries.

The federal government, meanwhile, has been increasingly concerned about provider network adequacy for public exchange plans. While recently finalized regulations largely defer to states to determine standards, it does plan to create a network-breadth rating system for Healthcare.gov plans.

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