Network Optimization And The Continuity Of Physicians In Medicaid Managed Care

Area of Science:

• Health Services Research
• Health Policy
• Managed Care

Background:

• Health plans utilize selective physician networks for cost control and quality improvement.
• Narrow networks, defined as plans employing 30% or less of local physicians, raise concerns regarding patient access and care continuity.

Purpose of the Study:

• To analyze trends in the adoption of narrow primary care physician networks by Medicaid managed care plans.
• To assess the impact of network narrowness on physician turnover and continuity of care.

Main Methods:

• Analysis of Medicaid managed care plan data from fourteen states between 2010 and 2015.
• Calculation of network narrowness based on physician market share.
• Assessment of physician turnover rates in narrow versus non-narrow networks.

Main Results:

• The proportion of Medicaid managed care plans with narrow networks decreased from 42% in 2011 to 27% in 2015.
• Average annual physician turnover was 12%, with 34% of physicians exiting within five years.
• Physician turnover was significantly higher in narrow networks (3% higher after one year, 20% higher after five years) compared to non-narrow networks.

Conclusions:

• While the use of narrow networks has declined, they present challenges to physician continuity.
• Effective physician network management requires monitoring both network breadth and physician retention.
• Strategies are needed to ensure stable physician networks for sustained patient care.