Variations in patient response to tiered physician networks

Area of Science:

• Health Services Research
• Healthcare Economics
• Health Policy

Background:

• Tiered provider networks aim to guide patients toward preferred healthcare providers.
• Previous research indicates varied effectiveness of these networks depending on context.

Purpose of the Study:

• To investigate if the impact of tiered physician networks differs across various patient demographics.
• To analyze the effect of physician tier rankings on patient choice and retention.

Main Methods:

• Cross-sectional analysis of administrative enrollment and claims data (FY2009-2010).
• Focus on nonelderly beneficiaries in Massachusetts Group Insurance Commission health plans.
• Utilized fixed effects linear regression models stratified by patient characteristics.

Main Results:

• Physicians with the lowest tier rankings experienced a 10-15% loss in market share among new patients who were older, sicker, or male.
• No significant impact on market share for new female or younger patients.
• Physician tier ranking did not influence patient switching rates across any patient groups.

Conclusions:

• Patient loyalty to physicians is a significant factor across all demographic groups.
• Tiered networks show potential for influencing healthcare value by affecting new patient acquisition, particularly among specific subgroups.
• The design of tiered networks may need to consider patient demographics for optimal impact.