Most Regionally Ranked Hospitals In Network With Marketplace Plans

After studying network participation by state, new research found nearly all highly ranked regional hospitals to be in network with at least one marketplace plan in both 2015 and 2016.

The study from the Robert Wood Johnson Foundation finds many consumers returning to the marketplace in 2016 may find that their choices have changed in ways that limit their access to certain providers. However, almost all of these highly rated hospitals are in network with at least one marketplace plan.

Background

The changes in marketplace plans between 2015 and 2016 have become an important issue recently. Some of the most significant changes relate to provider networks and access to out-of-network providers. Reports have suggested that the number of broad network plans, or preferred provider organizations (PPOs) offered in the marketplace have decreased in 2016.

“In the absence of comprehensive data, one way to gain insight is to measure changes in network participation in marketplace plans by a fixed cohort of providers between 2015 and 2016,” wrote the author of the study, Katherine Hempstead, PhD, MA.

For analysis, hospitals that are highly rated by the US News and World Report’s list of Best Regional Hospitals in 2015 were selected. The Best Regional Hospital category is limited to general medical-surgical hospitals that provide a wide range of services. The regional rankings included all metropolitan areas with population more than 1 million. Metropolitan areas with only one or no regionally ranked hospital were not included in the study.

Results

Nearly all of the highly ranked hospitals were in network with at least one marketplace plan in both 2015 and 2016. The participation rate remained high with 97% in 2015 and 96% in 2016. However, the number of networks in which these hospitals participated declined marginally. Only 43% of these hospitals maintained or increased the number of marketplace networks while 57% of hospitals participated in fewer networks in 2016.

In terms of plan participation regionally, the overall distribution shifted notably. The proportion of hospitals that were in only one network nearly tripled, from 11 in 2015 to 31 in 2016.

In 2016, 24% of hospitals participated in one or zero networks, as compared with 10% in 2015. Similarly, there were fewer hospitals participating in large numbers of networks. In 2015, 50% of hospitals participated in four or more networks but in 2016, only 34% of hospitals did.

Conclusion

Network participation declined more in metropolitan areas. These changes in network participation can occur for a variety of reasons—either because a carrier exits the market, or because they become insolvent and fail, or a carrier may choose not to sell marketplace plans in a particular state.

In most cases, customers loyal to a particular hospital still find a marketplace plan that includes it, but choices are narrowed in 2016 relative to 2015.