Study Queries Cost—Quality Tradeoff in Narrow Oncology Provider Networks

Researchers at the University of Pennsylvania (UPenn) have recognized that narrow provider networks are quite likely to exclude National Cancer Institute (NCI)—Designated Cancer Centers or National Comprehensive Cancer Network (NCCN) Cancer Centers. This could prevent patient access to high-quality cancer care.

Inclusion or exclusion of providers in a health plan’s network may be influenced by the need for health insurers to provide price-competitive insurance plans, since research studies have shown that narrow provider networks can lower premiums—a result of lower provider rates, selective contracting with providers who treat lower-cost enrollees, or exclusion of providers who treat higher-cost enrollees.

“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 lead author Laura Yasaitis, PhD, a postdoctoral researcher at UPenn’s Leonard Davis Institute of Health Economics.

But does this lead to a compromise of high-quality care for patients? With this query in mind, researchers at UPenn mined a US oncologist database to identify oncologists (hematology/oncology or radiation oncology) affiliated with one of 69 NCI-Designated Cancer Centers—within this list was a subset of 27 NCCN Centers. With a focus on clinically relevant and policy-relevant setting of individual market place exchanges under the Affordable Care Act, network size was determined for the oncologists included in the study. Network breadth, defined as the number of oncologists practicing in that market and participating in the network divided by the total number of oncologists practicing in that market, was associated with whether the network was more or less likely to include high-quality oncologists (defined by NCI affiliation).

The analysis found that in regions with NCI-Designated Cancer Centers, there were 13.7 oncologists for every 100,000 residents and 4.9 networks (standard deviation [SD], 2.8) covered a mean 39.4% (SD, 26.2%) of these oncologists. This, compared with 8.8 oncologists for every 100,000 residents and 3.2 networks (SD, 2.1) that covered on average 49.9% (SD, 26.8%) of the area’s oncologists in markets that lacked an NCI-Designated Cancer Center.

This means that while the supply of oncologists was higher in markets that had NCI-Designated Cancer Centers, health plan networks were narrower in these regions. A similar trend was observed when the authors evaluated the subset of NCCN Cancer Centers.

“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,” according to Daniel Polsky, PhD, executive director of the Leonard Davis Institute of Health Economics who is a senior author on the study.

Indicating that problems with transparency and access are the major findings of their study, the authors recommend that insurance companies, state regulators, and federal lawmakers should ensure consumers are educated on whether providers of cancer care with particular affiliations are in or out of narrow provider networks.

The study has been published in the Journal of Clinical Oncology.