The average Obamacare health plan’s provider network includes 34 percent fewer health care providers than the typical commercial plan, according to an analysis by Avalere, a Washington, D.C.-based health care consultancy.
Such exchange plan networks include 42 percent fewer oncologists and cardiologists, 32 percent fewer mental health experts and primary care doctors, and 24 percent fewer hospitals, Avalere said Wednesday. The study that supports complaints by some consumers and advocacy groups that some of the exchanges created under the Affordable Care Act offer “narrow networks” where patient options are considerably constrained.
Those same five categories (oncologists, cardiologists, mental health specialists, primary care doctors and hospitals) are used by the federal Centers for Medicare and Medicaid Services or CMS in evaluating whether health plans that participate in exchanges under the Affordable Care Act meet its “adequacy standards.”
But Avalere’s analysis was meant to quantify “anecdotal reports that exchange networks contain fewer providers” and explore how different health plan designs work (or don’t work) on the exchanges, as opposed to attempting to provide ammunition in the political and consumer advocacy battles over narrow exchanges.
“Given the new requirements put in place by the ACA, network design is one way plans can drive value-based care and keep premiums low,” Dan Mendelson, Avalere’s CEO, said in the statement. Both are key goals of President Barack Obama’s signature health care reform law, which was upheld again last month by the U.S. Supreme Court.