Publications
Publications
- September 2017
- Journal of Clinical Oncology
Helping Patients with Cancer Navigate Narrow Networks
By: Stephen M. Schleicher, Emeline M. Aviki and Thomas W. Feeley
Abstract
The Affordable Care Act of 2010 (ACA) was designed primarily to improve patient access to affordable health care. The access-expanding provisions of the ACA included federal- and state-based health insurance exchanges with minimum coverage requirements and preexisting disease protection clauses. One effect of these access-expanding measures has been increased costs for insurers. Narrow networks, which limit patient access to certain hospitals and physician groups, represent a strategy for insurers to remain competitive in the face of increased costs. Narrow networks lower insurance premiums, in part by funneling patients toward lower-cost providers. We previously hypothesized that narrow networks might be used to adversely select against the enrollment of patients with costly chronic diseases like cancer and found that narrow networks commonly excluded stand-alone cancer hospitals, such as Memorial Sloan Kettering Cancer Center and the University of Texas MD Anderson Cancer Center. The exclusion of National Center Institute (NCI) designated cancer centers from narrow health plans is a symptom that our cancer care delivery system remains broken after the ACA. Whether we see a replacement for the ACA or a completely new health care law, the focus moving forward should be on transparency, insurance literacy, and value for patients—the best outcomes at the lowest cost.
Keywords
Citation
Schleicher, Stephen M., Emeline M. Aviki, and Thomas W. Feeley. "Helping Patients with Cancer Navigate Narrow Networks." Journal of Clinical Oncology 35, no. 27 (September 2017): 3095–3096.