In contrast to commercial markets, narrow networks in Medicare Advantage (MA) markets are not motivated by unit-price discounts for insurers in exchange for higher patient volume for health systems. Through 15 interviews with MA experts, MA insurers, and health systems, we confirmed that the Medicare fee schedule is the basis for most provider payments in MA regardless of network breadth. Cost savings from narrow networks in MA derive from established health systems’ lower utilization and higher quality. MA star ratings, in particular, are a key consideration when forming networks, as high star ratings provide financial benefits. This article is available here.
Policy Research & Analysis
The National Institute for Health Care Reform (NIHCR) contracted with the Center for Studying Health System Change (HSC) between 2009 and 2013 to conduct health policy research and analyses to improve the organization, financing and delivery of health care in the United States. HSC ceased operations on Dec. 31, 2013, after merging with Mathematica Policy Research, which assumed the HSC contract to complete NIHCR projects. Beginning in 2014, NIHCR has contracted with Altarum Institute’s Center for Sustainable Health Spending and others, with a focus on research to improve health in Detroit.