Many health insurers now rank their physicians into tiers based on quality and cost and provide financial incentives to members for choosing a doctor in a higher tier. These tiered networks are designed to promote competition and quality improvement among providers.
However, a new study from Health Services Research found that while patients selecting a tiered doctor for a first-time visit were likely to choose one ranked in the best performing or average tier, patients who had an ongoing relationship with a doctor in a lower performing tier were no more apt to switch than patients with higher ranked doctors.
“These findings are economically important for physicians as these results correspond to a loss in market share of new patients for a doctor in the worse performing tiers compared to those in better tier rankings,” said the study’s lead author, Anna D. Sinaiko, Ph.D., research scientist in the department of health policy and management at the Harvard School of Public Health.
The researchers compared administrative claims and enrollment information of 171,581 patients who were in a tiered physician network that ranked quality performance and efficiency of health plans through the Massachusetts Group Insurance Commission. Twenty percent of physicians were in the top or highest performing tier, 65 percent in the middle and 15 percent were ranked in the lowest performing tier.
Patients with doctors in lower performing tiers may not have had enough financial incentive to switch or may have been unaware of the tiered rankings, suggest the authors.
The study found a low amount of health plan switching and high degree of patient loyalty to physicians they’d seen in the past. In fact, patients with doctors ranked in the lowest performing tier were more likely to switch health plans than other patients. That may be due to patients feeling frustrated that their physician was in low ranked tier or unhappy about having to pay a higher co-pay to see their lower ranked physician, the authors speculate.
Sinaiko pointed out, “Our study underscores the loyalty that patients feel for their own physicians. Likewise, the fact that we observed an impact of tier-rankings on new patient visits also makes sense. Unknown physicians are more likely to be viewed by patients as [more] substitutable than are physicians with whom they already have a relationship.”
Robert Zirkelbach, spokesman and vice-president of strategic communications for America’s Health Insurance Plans in Washington, D.C., said, “It is important to ensure patients can continue to benefit from the high-value provider networks health plans have established, which are helping to improve quality and mitigate cost increases for consumers as the new health care reforms are taking effect.”
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Health Services Research is the official journal of the Academy Health and is published by John Wiley & Sons, Inc. on behalf of the Health Research and Educational Trust. For information, contact Jennifer Shaw, HSR Business Manager at (312) 422 2646 or [email protected]. HSR is available online at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1475-6773/