Department of Health Policy, Department of Medicine, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Department of Health Policy, Vanderbilt University, Nashville, Tennessee, USA.
Health Serv Res. 2023 Oct;58(5):1056-1065. doi: 10.1111/1475-6773.14138. Epub 2023 Mar 15.
To quantify shared patient relationships between primary care physicians (PCPs) and cardiologists and oncologists and the degree to which those relationships were captured within insurance networks.
Secondary analysis of Vericred data on physician networks, CareSet data on physicians' shared Medicare patients, and insurance plan attributes from Health Insurance Compare. Data validation exercises used data from Physician Compare and IQVIA.
Cross-sectional study of the PCP-to-specialist in-network shared patient percentage (primary outcome). We also categorized networks by insurance market segment (Medicare Advantage [MA], Medicaid managed care, small-group or individually purchased), insurance plan type, and network breadth.
We analyzed data on 219,982 PCPs, 29,400 cardiologists, and 22,745 oncologists who, in 2021, accepted MA (n = 941 networks), Medicaid managed care (n = 293), and individually-purchased (n = 332) and small-group (n = 501) plans.
Networks captured, on average, 64.6% of PCP-cardiology shared patient ties, and 61.8% of PCP-oncologist ties. Less than half of in-network ties (44.5% and 38.9%, respectively) were among physicians with a common organizational affiliation. After adjustment for network breadth, we found no evidence of differences in the shared patient percentage across insurance market segments or networks of different types (p-value >0.05 for all comparisons). An exception was among national versus local and regional networks, where we found that national plans captured fewer shared patient ties, particularly among the narrowest networks (58.4% for national networksvs. 64.7% for local and regional networks for PCP-cardiology).
Given recent trends toward narrower networks, our findings underscore the importance of incorporating additional and nuanced measures of network composition to aid plan selection (for patients) and to guide regulatory oversight.
量化初级保健医生（PCP）与心脏病专家和肿瘤学家之间的共同患者关系，以及这些关系在保险网络中被捕捉到的程度。
对 Vericred 医生网络数据、CareSet 医生共享医疗保险患者数据以及 Health Insurance Compare 保险计划属性的二次分析。数据验证工作使用了 Physician Compare 和 IQVIA 的数据。
PCP 与专科医生的网络内共享患者百分比（主要结果）的横截面研究。我们还根据保险市场细分（医疗保险优势计划 [MA]、医疗补助管理式护理、小团体或个人购买）、保险计划类型和网络广度对网络进行了分类。
我们分析了 2021 年接受 MA（n=941 个网络）、医疗补助管理式护理（n=293）、个人购买（n=332）和小团体（n=501）计划的 219982 名 PCP、29400 名心脏病专家和 22745 名肿瘤学家的数据。
网络平均捕捉到 64.6%的 PCP-心脏病学共享患者关系，61.8%的 PCP-肿瘤学家关系。不到一半的网络内关系（分别为 44.5%和 38.9%）存在于具有共同组织隶属关系的医生之间。在调整网络广度后，我们没有发现保险市场细分或不同类型网络之间共享患者百分比存在差异（所有比较的 p 值均大于 0.05）。一个例外是在全国性与地方性和区域性网络之间，我们发现全国性计划捕捉到的共享患者关系较少，特别是在最狭窄的网络中（全国性网络的 PCP-心脏病学共享患者关系为 58.4%，地方性和区域性网络为 64.7%）。
鉴于最近网络趋于狭窄的趋势，我们的研究结果强调了纳入网络组成的额外和细致措施的重要性，以帮助患者选择计划，并指导监管监督。
