Primary care docs easier to find in ACA plans than Medicaid, study finds

Les Masterson

Aug. 13, 2018

Dive Brief:

• Primary care physicians accept Affordable Care Act exchange plans more often than Medicaid, but not as much as employer-sponsored health insurance, according to a Health Affairs study.
• The analysis found that PCP in-network participation was 91% in the ACA marketplace. That's compared to 75% in Medicaid and 100% for employer-sponsored plans.
• The researchers also discovered that one-third of in-network physicians don't have appointments available for new Medicaid patients.

Dive Insight:

Narrow networks have become commonplace in both ACA plans and Medicaid, used by payers to control costs and ensure physicians provide quality care by meeting specific measures. Those networks remain rare in the employer-sponsored market, though. 

Members usually prefer broader networks, and narrower networks can increase frustrations and disrupt continuity of care.

The study authors suggested that the results provide insight into the challenges that patients face. The findings can also "assist policymakers in recognizing the trade-offs involved in allocating scarce resources while improving access to high-quality healthcare."

The report looked at the in-network rate for PCPs for 10 states: Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania and Texas.

The 10-state appointment availability average was 73% for ACA plans, 83% for employer-based coverage and only 63% for Medicaid. Those rates were consistent across all states studied. The only state where ACA plans had worse numbers to Medicaid was in Massachusetts (51.9% for ACA plans; 55.3% for Medicaid).

Study authors said the differences in choice of providers for each insurance type shows "inherent trade-offs in increasing coverage."

“Policies to expand physicians' participation in the marketplaces will depend on policy priorities, beneficiaries' preferences and whether the benefits outweigh the costs of expanding physician participation in various insurance market segments," they added.

An Avalere report last year found that more restrictive networks make up 73% of ACA plans. That’s an increase from 68% in 2017 and 54% in 2015.

In comparison, Kaiser Family Foundation said only 8% of companiesoffering health benefits had narrow networks in 2017. That was the same percentage as the previous year. A mere 6% of companies said they eliminated hospitals or health systems from a network over the past year to reduce cost.

Medicaid managed care plans also offer narrow network plans. However, a Health Affairs report warned about physician turnover in those plans. That report found that Medicaid narrow networks had a three percentage point higher turnover rate in one year and 20 percentage point higher rate through five years compared to non-narrow network plans.

https://www.healthcaredive.com/news/primary-care-docs-easier-to-find-in-aca-plans-than-medicaid-study-finds/529872/