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Many ‘narrow network’ insurance plans exclude top cancer centers
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Certain provider networks restrict access to oncologists affiliated with NCI-designated or National Comprehensive Cancer Network cancer centers, according to published findings.
Researchers suggest these restrictions imposed by insurance companies — also known as “narrow networks” — may be limiting patients’ access to care.
“Consumers may benefit financially from the fact that these narrow networks generally have lower premiums, but they may face reduced access to the higher-quality providers in their market,” Daniel Polsky, PhD, professor of medicine in the division of general internal medicine, and executive director of the Leonard Davis Institute of Health Economics at University of Pennsylvania, said in a press release.
Narrow network providers are more likely to have lower premiums as a result of lower provider imbursement rates, contracting with providers with lower-cost enrollees or excluding providers associated with high-cost enrollees.
“Because cancer care and monitoring is costly, there are strong incentives for insurers to be selective when it comes to oncologists, excluding those who are most likely to attract the most complex and expensive cases,” Laura Yasaitis, PhD, postdoctoral researcher at Leonard David Institute of Health Economics, said the release.
NCCN cancer centers are associated with higher quality care and NCI-designated cancer centers are linked to lower mortality rates, especially among patients severe disease. Therefore, these centers likely attract patients who need high-cost care.
Polsky, Yasaitis and Justin E. Bekelman, MD, associate professor in the department of radiation oncology at Perelman School of Medicine and Leonard Davis Institute of Health Economics, systematically evaluated cancer center markets from the 2014 individual health insurance exchanges to determine how many oncologists affiliated with NCI and NCCN were excluded from narrow markets.
Fifty-one markets contained at least one of the 69 NCI-designated cancer centers, and the subset of 27 NCCN cancer centers were located in 27 different rating areas.
A total 12,392 oncologists practiced in the 51 markets, of whom 7,990 also practiced in the markets with NCCN cancer centers.
A higher number of oncologists practicing in markets with NCI-designated cancer centers were excluded from all networks (26.2% vs. 18.1%; P < .001). However, a higher number of these oncologists were included in four or more networks (23.8% vs. 17.1%; P < .001).
The 51 markets that included NCI-designated cancer centers had 13.7 oncologists per 100,000 residents, with 4.9 (standard deviation [SD], 2.8) networks covering on average 39.4% (SD, 26.2%) of those oncologists. Conversely, markets that excluded NCI-designated centers had 8.8 oncologists per 100,000 residents, with 3.2 (SD, 2.1) networks covering on average 49.9% (SD, 26.8%) of the area’s oncologists (P < .001 for all comparisons).
In the subset of markets with an NCCN cancer center, oncologist supply, network breadth and mean number of covered oncologists per 100,000 residents appeared comparable to corresponding results in markets with a non-NCCN NCI-designated cancer center.
Researchers observed a significant correlation between a network’s breadth and its relative inclusion of oncologists associated with NCI-designated cancer centers (r = 0.44; P < .001), which suggested narrower oncology networks have fewer oncologists affiliated with NCI-designated cancer centers. The correlation persisted in the subset of NCCN markets (r = 0.42; P < .001).
The researchers suggested insurers report doctors’ affiliations with NCI and NCCN Cancer Centers so consumers can make informed choices.
“Patients should be able to easily figure out whether the physicians they might need will be covered under a given plan,” Bekelman said in the release, adding that there should be a standard exception process put in place for patients with narrow network plans to allow them access to the care they need. – by Melinda Stevens
Disclosure: Polsky reports research funding to his institution from Pfizer. Yasaitis reports no relevant financial disclosures. Bekelman reports he is a consultant/advisor with Gerson Lehrman Group.
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