The Impact of Narrow and Tiered Networks on Costs, Access, Quality, and Patient Steering: A Systematic Review

Overview

Journal Med Care Res Rev

Specialty Health Services

Date 2021 Nov 10

PMID 34753330

Citations 1

Authors

Olena Mazurenko

Heather L Taylor

Nir Menachemi

Affiliations

Soon will be listed here.

Abstract

Health insurers use narrow and tiered networks to lower costs by contracting with, or favoring, selected providers. Little is known about the contemporary effects of narrow or tiered networks on key metrics. The purpose of this systematic review was to synthesize the evidence on how narrow and tiered networks impact cost, access, quality, and patient steering. We searched PubMed, MEDLINE, and Cochrane Central Register of Controlled Trials databases for articles published from January 2000 to June 2020. Both narrow and tiered networks are associated with reduced overall health care costs for most cost-related measures. Evidence pertaining to access to care and quality measures were more limited to a narrow set of outcomes or were weak in internal validity, but generally concluded no systematic adverse effects on narrow or tiered networks. Narrow and tiered networks appear to reduce costs without affecting some quality measures. More research on quality outcomes is warranted.

Citing Articles

Variation in tiered network health plan penetration and local provider market characteristics.

Sinaiko A, Curto V, Bambury E, Soto M, Rosenthal M Health Serv Res. 2023; 59(4):e14223.

PMID: 37670453 PMC: 11250427. DOI: 10.1111/1475-6773.14223.

References

Polsky D, Cidav Z, Swanson A . Marketplace Plans With Narrow Physician Networks Feature Lower Monthly Premiums Than Plans With Larger Networks. Health Aff (Millwood). 2016; 35(10):1842-1848. DOI: 10.1377/hlthaff.2016.0693. View

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7):e1000097. PMC: 2707599. DOI: 10.1371/journal.pmed.1000097. View

Haeder S, Weimer D, Mukamel D . California hospital networks are narrower in Marketplace than in commercial plans, but access and quality are similar. Health Aff (Millwood). 2015; 34(5):741-8. DOI: 10.1377/hlthaff.2014.1406. View

Graves J, Nshuti L, Everson J, Richards M, Buntin M, Nikpay S . Breadth and Exclusivity of Hospital and Physician Networks in US Insurance Markets. JAMA Netw Open. 2020; 3(12):e2029419. PMC: 7747020. DOI: 10.1001/jamanetworkopen.2020.29419. View

Scanlon D, Lindrooth R, Christianson J . Steering patients to safer hospitals? The effect of a tiered hospital network on hospital admissions. Health Serv Res. 2008; 43(5 Pt 2):1849-68. PMC: 2654164. DOI: 10.1111/j.1475-6773.2008.00889.x. View

Brennan T, Spettell C, Fernandes J, Downey R, Carrara L . Do managed care plans' tiered networks lead to inequities in care for minority patients?. Health Aff (Millwood). 2008; 27(4):1160-6. DOI: 10.1377/hlthaff.27.4.1160. View

Polsky D, Weiner J, Zhang Y . Exploring the decline of narrow networks on the 2017 ACA marketplaces. LDI Issue Brief. 2017; 21(9):1-6. View

Howard D . Hospital Quality and Selective Contracting: Evidence from Kidney Transplantation. Forum Health Econ Policy. 2008; 11(2):2. PMC: 2600561. DOI: 10.2202/1558-9544.1088. View

McKenna R, Pintor J, Ali M . Insurance-Based Disparities In Access, Utilization, And Financial Strain For Adults With Psychological Distress. Health Aff (Millwood). 2019; 38(5):826-834. DOI: 10.1377/hlthaff.2018.05237. View

10.

Fortney J, Thill J, Zhang M, Duan N, Rost K . Provider choice and utility loss due to selective contracting in rural and urban areas. Med Care Res Rev. 2001; 58(1):60-75. DOI: 10.1177/107755870105800104. View

11.

Haeder S, Weimer D, Mukamel D . A Consumer-Centric Approach To Network Adequacy: Access To Four Specialties In California's Marketplace. Health Aff (Millwood). 2019; 38(11):1918-1926. DOI: 10.1377/hlthaff.2019.00116. View

12.

Ho K . Insurer-Provider Networks in the Medical Care Market. Am Econ Rev. 2018; 99(1):393-430. DOI: 10.1257/aer.99.1.393. View

13.

Tackett S, Stelzner C, McGlynn E, Mehrotra A . The impact of health plan physician-tiering on access to care. J Gen Intern Med. 2010; 26(4):440-5. PMC: 3055960. DOI: 10.1007/s11606-010-1607-3. View

14.

Frank M, Hsu J, Landrum M, Chernew M . The Impact of a Tiered Network on Hospital Choice. Health Serv Res. 2015; 50(5):1628-48. PMC: 4600365. DOI: 10.1111/1475-6773.12291. View

15.

Rosenthal M, Li Z, Milstein A . Do patients continue to see physicians who are removed from a PPO network?. Am J Manag Care. 2009; 15(10):713-9. View

16.

Atwood A, Lo Sasso A . The effect of narrow provider networks on health care use. J Health Econ. 2016; 50:86-98. DOI: 10.1016/j.jhealeco.2016.09.007. View

17.

Howard D . Adverse effects of prohibiting narrow provider networks. N Engl J Med. 2014; 371(7):591-3. DOI: 10.1056/NEJMp1402705. View

18.

Buntin M, Graves J . How The ACA Dented The Cost Curve. Health Aff (Millwood). 2020; 39(3):403-412. DOI: 10.1377/hlthaff.2019.01478. View

19.

Sinaiko A, Rosenthal M . The impact of tiered physician networks on patient choices. Health Serv Res. 2014; 49(4):1348-63. PMC: 4239853. DOI: 10.1111/1475-6773.12165. View

20.

Wholey D, Feldman R, Christianson J . The effect of market structure on HMO premiums. J Health Econ. 1995; 14(1):81-105. DOI: 10.1016/0167-6296(94)00039-7. View