The only link between narrow networks and quality was found in networks with between one and three hospitals. In those cases, the low scores were thought to be due to one poorly performing hospital dragging down the overall rating.
This story originally appeared in California Healthfax.
A new study found that the number of hospitals in narrow network plans sold on Covered California does not impact the quality of care provided under those plans.
The study from the California HealthCare Foundation (CHCF) and Cynosure Health Solutions titled 'Narrow Networks: Does Limited Choice of Hospitals Affect Quality in Covered California?' looked at a range of narrow network plans sold on the health insurance exchange. The study used clinical data on quality of care from the California Hospital Assessment and Reporting Task Force and information on premiums from Covered California.
Overall, the report found the difference in quality among narrow networks was "not clinically significant" and that, in most cases, the size of a network had no impact on the overall quality of care provided by a health plan. The study stated that "limited hospital network structure was not seen to influence quality performance" and that any concerns about narrow networks should focus on access to care rather than quality of care.
"While there was a difference in quality of care in health plans in different regions of the state, the size of the networks was not a factor in most instances," said Bruce Spurlock, MD, president and CEO for Cynosure Health Solutions and lead author of the study.
The study found the number of hospitals included in networks ranged from 1 to 32 with an average of 10 hospitals per network. The study noted that "while network narrowness has been linked to lower premiums, the research found no relationship between the number of hospitals in a network and the composite quality performance score."
Spurlock said the only link between narrow networks and quality was found in networks with between one and three hospitals, which had the lowest scores. In those cases, Spurlock said the low scores were probably due to one poorly performing hospital dragging down the overall rating.
The study found that health plans in the Bay Area and Northern California had the highest scores for quality of care. The highest-rated plans with an average score of 87 were located in San Francisco County followed by San Mateo County (86.5), North Bay Counties (86.5), and Santa Clara County (85.8). The lowest-rated plans were located in Kern County (78.9), Orange County (79.9), and Eastern Counties (80.6). The study also found that individual hospital scores ranged from 77 to 92 and reflected "a fairly narrow range of performance." It also found "a tightly bunched level of performance" among all narrow network health plans.
Spurlock said the study results indicate that lower-priced narrow network plans could become more popular as price-conscious consumers drive the market. The study noted that consumers "can choose different plan products with high confidence that they will receive generally equivalent hospital care."
"In the commercial space, buyers are typically looking for plans that offer the largest number of hospitals and medical groups to provide care," said Spurlock. "But that's not the case with consumers who are mainly looking for lower premiums rather than more options."
He said that dynamic may change the way insurers pick and choose hospitals and health systems when building narrow networks and that insurers may begin excluding higher-priced hospitals in an effort to keep premiums lower.
This story originally appeared in California Healthfax.