Jove
Visualize
Contact Us
JoVE
x logofacebook logolinkedin logoyoutube logo
ABOUT JoVE
OverviewLeadershipBlogJoVE Help Center
AUTHORS
Publishing ProcessEditorial BoardScope & PoliciesPeer ReviewFAQSubmit
LIBRARIANS
TestimonialsSubscriptionsAccessResourcesLibrary Advisory BoardFAQ
RESEARCH
JoVE JournalMethods CollectionsJoVE Encyclopedia of ExperimentsArchive
EDUCATION
JoVE CoreJoVE BusinessJoVE Science EducationJoVE Lab ManualFaculty Resource CenterFaculty Site
Terms & Conditions of Use
Privacy Policy
Policies

Related Experiment Videos

Overlap in HMO physician networks.

Michael E Chernew1, Walter P Wodchis, Dennis P Scanlon

  • 1University of Michigan School of Public Health, Department of Health Management and Policy, Ann Arbor, USA. mchernew@umich.edu

Health Affairs (Project Hope)
|March 30, 2004
PubMed
Summary
This summary is machine-generated.

Related Concept Videos

You might also read

Related Articles

Articles linked to this work by shared authors, journal, and citation graph.

Sort by
Same author

Insurer Retention of Stand-Alone Part D Plan Enrollees Switching to Medicare Advantage.

JAMA health forum·2026
Same author

Local implementation of the national opioid settlements: challenges and opportunities.

The American journal of managed care·2026
Same authorSame journal

The Opacity Of Price Transparency.

Health affairs (Project Hope)·2026
Same author

Year 1 Impact of Offering Non-Emergency Medical Transportation on Care Utilization Among Low-Income and Disabled Beneficiaries in Medicare Advantage.

Health services research·2026
Same author

Practice Pattern Changes After Adoption Of Diagnostic AI Tool Used In Conjunction With Cardiac Imaging.

Health affairs (Project Hope)·2026
Same author

Managed care reflections: a Q&A with A. Mark Fendrick, MD, and Michael E. Chernew, PhD.

The American journal of managed care·2026
Same journal

National Health Expenditure Projections, 2025-34: Strong Utilization Growth Initially, Legislative Impacts Later.

Health affairs (Project Hope)·2026
Same journal

State Medicaid Programs Face Increased Spending On Medicare Premiums.

Health affairs (Project Hope)·2026
Same journal

Not enough time.

Health affairs (Project Hope)·2026
Same journal

Medicaid Tobacco And Nicotine Cessation Treatment Rates Remained Low, 2019-24.

Health affairs (Project Hope)·2026
Same journal

Third-Party Convener Firms And The Rise Of Geographically Dispersed, High-Earning Medicare ACOs.

Health affairs (Project Hope)·2026
See all related articles

Health maintenance organizations (HMOs) may limit physician networks for cost control, but this affects patient access. Physician network overlap varies significantly, impacting patients switching plans or jobs.

Area of Science:

  • Health Services Research
  • Healthcare Management
  • Health Economics

Background:

  • Health maintenance organizations (HMOs) implement network size restrictions for cost containment and quality improvement.
  • These restrictions can create barriers to patient access to care and hinder transitions between health plans or employment.
  • Understanding physician network overlap is crucial for evaluating patient choice and continuity of care.

Purpose of the Study:

  • To examine the extent, variation, and predictors of physician network overlap within health maintenance organizations (HMOs).
  • To assess the likelihood of patients retaining their physicians when switching between HMOs.
  • To identify characteristics of HMOs associated with greater or lesser physician network overlap.

Main Methods:

Related Experiment Videos

  • Analysis of physician network data across various health maintenance organizations (HMOs).
  • Statistical examination of the degree of overlap in physician participation between different HMO networks.
  • Identification of HMO characteristics (e.g., model type, age, for-profit status, market size) as predictors of network overlap.

    • Main Results:

    • Physician network overlap in HMOs shows considerable variation, with an interquartile range from 34% to 69%.
    • Patients switching HMOs have a moderate likelihood (approximately 50%) of retaining their current physician.
    • Group/staff-model HMOs exhibit minimal overlap, whereas younger, for-profit, and small-market plans demonstrate greater overlap.

    Conclusions:

    • HMO physician network overlap is variable and influenced by plan characteristics, impacting patient continuity of care.
    • The findings suggest that while some patients can maintain their physician when switching plans, significant barriers may still exist.
    • Policy and management strategies should consider network overlap to balance cost-efficiency with patient access and choice.