Evaluating network adequacy of oral health services for children on Medicaid in Arizona

<abstract><sec> <title>Purpose</title> <p>Inadequate networks can prevent patients from being able to see the providers that they trust and depend upon, especially for children insured through Medicaid. To improve our understanding of poor oral health care outcomes, we conducted a test of network adequacy among Medicaid pediatric dental providers in Arizona through a “secret shopper” phone survey.</p> </sec><sec> <title>Methods</title> <p>This study tested multiple components of children's access to oral health care, including reliability of provider directory information, appointment availability at the practice level for children covered under Medicaid versus commercial insurance, and compliance with regulatory standards. We contacted individual providers, following a standardized script to schedule a routine appointment on behalf of a 5-year-old patient enrolled in either a Medicaid or commercial plan. We documented the time until the next available appointment, if the practice was reached, and if the practice accepted the specified insurance plan.</p> </sec><sec> <title>Results</title> <p>We identified, catalogued, and attempted to call a total of 185 unique practices across Arizona. In four counties, we were unable to identify a single pediatric oral health provider through health plan directories. We observed minimal differences in appointment wait times between callers with commercial insurance and those insured through Medicaid.</p> </sec><sec> <title>Conclusions</title> <p>Our findings underscore the need to improve the accessibility of pediatric health services, especially in rural regions. Facilitating access to routine and recommended oral health screenings for children enrolled in Medicaid is imperative to appropriate stewardship and fulfilling our commitment to provide this vital public health resource.</p> </sec></abstract>

Improving Health Care Network Adequacy Through Spatial Analysis Utilizing GIS Technology

Network adequacy is a set of regulations a provider’s office must follow. Requirements are dependent on what funding they are receiving from the government, insurance companies, and other paying entities. Network adequacy at a provider’s office should be able to prove that they are providing their patients reasonable access to care. Generating these reports is currently a timely and costly process. Using GIS can improve the efficiency of generating and turning in their network adequacy reports to the required entities which would help save time and money. Having a way for providers offices to spend less time on these reports would allow for them to have more time to give to patients. Utilizing GIS to see the providers accessibility to patients can also show health care facilities where there are underserved areas, which would allow them to build new locations and add new providers. This paper shows the benefit of integrating GIS into the health field and how both provider facilities and patients can gain from this integration. Using the two-step floating catchment area method combined with ArcGIS Pro proved to be beneficial to calculating network adequacy and can be seen in the results of this paper.

Going the Extra Mile? How Provider Network Design Increases Consumer Travel Distance, Particularly for Rural Consumers

Context: The practical accessibility to medical care facilitated by health insurance plans depends not just on the number of providers within their networks but also on distances consumers must travel to reach the providers. Long travel distances inconvenience almost all consumers and may substantially reduce choice and access to providers for some. Methods: The authors assess mean and median travel distances to cardiac surgeons and pediatricians for participants in (1) plans offered through Covered California, (2) comparable commercial plans, and (3) unrestricted open-network plans. The authors repeat the analysis for higher-quality providers. Findings: The authors find that in all areas, but especially in rural areas, Covered California plan subscribers must travel longer than subscribers in the comparable commercial plan; subscribers to either plan must travel substantially longer than consumers in open networks. Analysis of access to higher-quality providers show somewhat larger travel distances. Differences between ACA and commercial plans are generally substantively small. Conclusions: While network design adds travel distance for all consumers, this may be particularly challenging for transportation-disadvantaged populations. As distance is relevant to both health outcomes and the cost of obtaining care, this analysis provides the basis for more appropriate measures of network adequacy than those currently in use.

Quality Advantage? Provider Quality and Networks in Medicare Advantage

Medicare Advantage plans have grown significantly over the past decade and the potential for their future growth seems unabated. Astonishingly, however, we know little about how Medicare beneficiaries access services, particularly whether those services are of high quality. This study explores access to cardiac surgeons for coronary artery bypass grafting (CABG) and heart valve surgery in California and New York. It is one of the first studies to analyze Medicare Advantage networks and interactions between provider networks and provider quality. Results of the study show that for large metropolitan areas, access is rather similar for traditional Medicare and Medicare Advantage beneficiaries. Limitations, however, exist for the latter. Important concerns emerge for Medicare Advantage beneficiaries outside of metropolitan areas where healthcare market challenges appear to be exacerbated by carrier restrictions. Results indicate no evidence that carriers selectively contract to improve quality. There is, however, significant diversity with regard to network breadth; and, this breadth does not stay static across distances. These results hold important implications for the future of the Medicare program, network adequacy regulations, and how consumers make choices about their insurance coverage.