- Cancer patients may have limited access to top-tier healthcare options if enrolled in narrow insurance networks, according to a study from the Perelman School of Medicine at the University of Pennsylvania.
Policymakers and payers have a responsibility to educate beneficiaries about the offerings available to them, the study asserts, and help them understand their financial responsibilities if they choose to engage with out-of-network oncology providers.
“Because cancer care and monitoring is costly, there are strong incentives for insurers to be selective when it comes to oncologists, excluding those who are most likely to attract the most complex and expensive cases,” said Laura Yasaitis, PhD, the study's co-author and a postdoctoral researcher at the University of Pennsylvania.
The study looked at access to cancer providers that was available through narrow network plans on the 2014 individual health insurance exchanges. From those plans, the study identified ones that offered access to oncologists who were affiliated with National Comprehensive Cancer Network (NCCN) and National Cancer Institute (NCI)-Designated Cancer Centers.
Those provider networks were singled out due to their reputation for high quality care, expert physicians and leadership in research and clinical trials for cancer treatments. The NCI Designated Cancer Centers are also noted for a lower mortality rate when treating severely ill patients.
Oncologists affiliated with NCCN Member Institutions and NCI-Designated Cancer Centers were less likely to be included as in-network providers in narrow insurance networks, the study found..
“Consumers may benefit financially from the fact that these narrow networks generally have lower premiums, but they may face reduced access to the higher-quality providers in their market,” said Daniel Polsky, PhD, executive director of the Leonard Davis Institute of Health Economics and the study’s co-senior author.
Narrow networks have grown in numbers since the introduction of the Affordable Care Act (ACA). Originally, narrow networks were designed to fulfill a cost containment function in the healthcare marketplace. The plans typically charge lower premiums, but also offer a limited number of participating providers, specialists and facilities. These plans usually work best for younger, healthier members who don’t require extensive specialist care.
According to a previous report on narrow networks by the Robert Wood Johnson Foundation (RWJF), payers can use the strategy to lower premiums in various ways, including to “directly exclude high-cost providers from the network and direct patients to high-value providers.”
This can leave members particularly “vulnerable to the financial burden of out-of-network care” by being forced to navigate between in-network providers where fewer options are available.
The RWJF report also suggested that payers should be transparent about the parameters of care in narrow networks in order to ensure that consumers receive the most value from these plans.
“Well-functioning narrow networks will survive only if their characteristics are communicated more clearly to consumers and they are regulated to ensure,” the authors said.
The authors of the University of Pennsylvania report, further suggested that payers add NCI and NCCN Cancer Centers to narrow networks, as well as alerting potential members before they enroll.
“Patients should be able to easily figure out whether the physicians they might need will be covered under a given plan,” said the study’s co-senior author Justin E. Bekelman, MD.
“If patients have narrow network plans and absolutely need the kind of complex cancer care that they can only receive from one of these providers, there should be a standard exception process to allow patients to access the care they need,” added Bekelman.