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Narrow Networks Not Necessarily an Impediment to Care

A recent study in Health Affairs finds that although health plans from California’s state-operated health exchange Covered California have narrower networks than their private commercial counterparts, they still have comparable hospital access and in some cases, higher hospital quality scores. The study assessed Covered California plans and compared them to the equivalent private plans offered by participating insurers.

The study finds that in the vast majority of California, residents had access to at least one hospital within 15 miles. On average, 92% of California residents live within 15 miles of a marketplace network hospital, compared to a plan average of 93% for a private network hospital, suggesting that marketplace and private plans have similar levels of access to care.

More surprisingly, the study also finds that marketplace plans provide access to hospitals with similar or better quality assessment scores, depending on the set of metrics used. Based on an index of 12 AHRQ-specified quality indicators, differences in hospital quality were found to be statistically insignificant. However, measures from the Leapfrog Hospital Survey pointed to a slight but statistically significant quality advantage among marketplace hospitals.

The findings suggest that despite being portrayed as a failure on the part of public exchange plans, narrow networks are not necessarily an impediment to high quality and accessible hospital care. They also shed light on the need for further discussion of measures used to assess quality of care at hospitals to ensure that metrics accurately and reliably reflect patient experiences. Nonetheless, the issue of access to care remains pertinent – while this study notes rosy statewide averages, severe provider shortages still exist in many areas across California and the United States.

The full study can be read at Health Affairs, but a subscription or one-time fee is required for access.

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