title: Secret Shoppers Find Access To Providers And Network Accuracy Lacking For Those In Marketplace And Commercial Plans.
abstract: The adequacy of provider networks for plans sold through insurance Marketplaces established under the Affordable Care Act has received much scrutiny recently. Various studies have established that networks are generally narrow. To learn more about network adequacy and access to care, we investigated two questions. First, no matter the nominal size of a network, can patients gain access to primary care services from providers of their choice in a timely manner? Second, how does access compare to plans sold outside insurance Marketplaces? We conducted a "secret shopper" survey of 743 primary care providers from five of California's nineteen insurance Marketplace pricing regions in the summer of 2015. Our findings indicate that obtaining access to primary care providers was generally equally challenging both inside and outside insurance Marketplaces. In less than 30 percent of cases were consumers able to schedule an appointment with an initially selected physician provider. Information about provider networks was often inaccurate. Problems accessing services for patients with acute conditions were particularly troubling. Effectively addressing issues of network adequacy requires more accurate provider information.
authors.affiliation: Simon F. Haeder (simon.haeder@mail.wvu.edu) is an assistant professor in the Department of Political Science at the John D. Rockefeller IV School of Policy and Politics, West Virginia University, in Morgantown. Previously he was a doctoral student in the Department of Political Science at the University of Wisconsin-Madison.
authors.forename: Simon F
authors.initials: SF
authors.lastname: Haeder
authors.affiliation: David L. Weimer is a professor in the La Follette School of Public Affairs at the University of Wisconsin-Madison.
authors.forename: David L
authors.initials: DL
authors.lastname: Weimer
authors.affiliation: Dana B. Mukamel is a professor in the Department of Medicine and the director of the iTEQC Research Program (Program of Research in Translational Technology Enabling High Quality Care), both at the University of California, Irvine.
authors.forename: Dana B
authors.initials: DB
authors.lastname: Mukamel
mesh_terms: D002140:California; D019058:Community Networks / Q000458:organization & administration*; D003258:Consumer Behavior / Q000706:statistics & numerical data*; D017046:Cost Savings; D016208:Databases, Factual; D005260:Female; D062265:Health Insurance Exchanges / Q000191:economics / Q000706:statistics & numerical data*; D006282:Health Personnel / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000191:economics*; D008297:Male; D008389:Marketing of Health Services; D058991:Patient Protection and Affordable Care Act / Q000191:economics*; D012189:Retrospective Studies
keywords: Access To Care; Affordable Care Act; Health Reform; Primary Care; Provider Networks