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Health Aff (Millwood). 2018 Jun;37(6):929-935. doi: 10.1377/hlthaff.2017.1410.

Network Optimization And The Continuity Of Physicians In Medicaid Managed Care.

Author information

1
Chima D. Ndumele ( chima.ndumele@yale.edu ) is an assistant professor of health policy in the Department of Health Policy and Management, Yale School of Public Health, in New Haven, Connecticut.
2
Becky Staiger is a graduate student in the Department of Health Policy and Management, Yale School of Public Health.
3
Joseph S. Ross is an associate professor of medicine in the Department of Internal Medicine, Yale School of Medicine, in New Haven.
4
Mark J. Schlesinger is a professor of health policy in the Department of Health Policy and Management, Yale School of Public Health.

Abstract

Health plans use selective physician networks to control costs while improving quality. However, narrow (limited) networks raise concerns about reduced access to and continuity of care. In the period 2010-15, the proportion of Medicaid managed care plans in fourteen states with narrow primary care physician networks-that is, the plans that employed 30 percent or less of those physicians in their market-declined from a peak of 42 percent in 2011 to 27 percent in 2015. On average, plans experienced a 12 percent annual turnover rate, with 34 percent of primary care physicians exiting within five years. Turnover was 3 percentage points higher in plans with narrow networks after one year, and 20 percentage points higher after five years, compared to turnover in plans with non-narrow networks. These findings suggest that efforts to maintain adequate physician networks must monitor not only the breadth of the networks, but also the continuity within them.

KEYWORDS:

Access To Care; Managed Care - Medicaid < Managed Care; Managed Care - Physicians < Managed Care; Workforce Issues

PMID:
29863934
DOI:
10.1377/hlthaff.2017.1410

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