The impact of tiered physician networks on patient choices

Area of Science:

• Health Economics
• Patient Behavior
• Healthcare Management

Background:

• Physician tiering, a strategy categorizing doctors based on cost or quality, is increasingly used by health plans.
• Understanding patient responses to tiering is crucial for healthcare system design and patient choice architecture.

Purpose of the Study:

• To investigate the impact of physician tiering on patient choices and health plan switching behavior.
• To differentiate the effects of tiering on existing versus new patient-physician relationships.

Main Methods:

• Analysis of patient data to assess switching behavior related to physician tiers.
• Comparison of choices made by patients selecting new physicians versus those staying with established doctors.

Main Results:

• Physician tiering did not significantly impact patient decisions to switch away from previously established physicians.
• Patients were less likely to select physicians in lower-tier or non-preferred categories when choosing a new doctor.
• Patients seeing physicians in the lowest tier demonstrated a higher likelihood of switching health plans post-tiering implementation.

Conclusions:

• Physician tiering influences new patient acquisition more than existing patient retention.
• The introduction of tiered networks can lead to health plan disenrollment among patients with lower-ranked physicians.
• Healthcare systems should consider these behavioral impacts when designing and implementing physician-tiering strategies.