Consumer Experience with a Tiered Physician Network: Early Evidence

Objective: To analyze consumer awareness, use, and trust of a tiered provider network, which differentiates copayments by provider cost-efficiency and quality.

Study Design: Mail survey of a plan-stratified random sample of individuals in health plans offered by the Massachusetts Group Insurance Commission.

Methods: Pearson's chi2 tests and multinomial logistic regression were used to analyze the effect of demographics and other characteristics on consumer awareness, understanding, trust, and use of a tiered provider network.

Results: Half (49.5%) of respondents reported prior knowledge of the tiered networks in their health plan. Whites, respondents who saw a specialist in the last year, and respondents who used the Internet for health information were more likely to be aware of the tiers. A majority of respondents either did not trust (35.5%) or did not know whether they trusted (22.5%) the tiers to tell them which physicians were better than others. Nineteen percent of respondents reported knowing which tier one of their physicians was in; of this group, 50.1% learned this information at or after their first visit. Respondents who learned their physician's tier before the first visit were more likely to find this information important to their decision to see that physician (60.5% vs 39.5%; P <.01).

Conclusions: These findings suggest use of tiered networks to direct consumers to preferred providers requires increased consumer awareness and trust in the health plan as a source for provider rankings. Efforts targeting consumers before they decide to see a physician may be more successful.