Table 1.
Narrow Networks by Contract and Enrollee Characteristics
| Primary Care | Psychiatry | Mental and Behavioral | ||||
|---|---|---|---|---|---|---|
| Plan characteristics | % Narrow | p value | % Narrow | p value | % Narrow | p value |
| % Enrollees | 30.5% | 43.1% | 83.2% | |||
| Type | ||||||
| HMO | 32.6 | 37.3 | 87.9 | |||
| PPO | 27.9 | 0.327 | 50.2 | 0.013 | 77.3 | 0.006 |
| Star rating | ||||||
| 2–2.5 | 20.0 | 62.0 | 91.2 | |||
| 3–3.5 | 23.6 | 0.952 | 29.6 | 0.608 | 84.6 | 0.89 |
| 4–4.5 | 32.3 | 0.834 | 47.3 | 0.816 | 84.0 | 0.88 |
| 5 | 50.1 | 0.624 | 50.1 | 0.856 | 50.8 | 0.415 |
| Unrated | 30.9 | 0.858 | 47.7 | 0.826 | 69.2 | 0.654 |
| Premium | ||||||
| < $10 | 31.9 | 35.6 | 86.9 | |||
| $10 to $40 | 31.1 | 0.879 | 51.3 | 0.016 | 82.4 | 0.358 |
| > $40 | 27.9 | 0.643 | 32.8 | 0.762 | 80.6 | 0.381 |
| Enrollment | ||||||
| Small (< 3000) | 47.1 | 48.8 | 79.5 | |||
| Medium (3000 to 20,000) | 34.4 | 0.83 | 38.5 | 0.948 | 76.2 | 0.923 |
| Large (> 20,000) | 39.4 | 0.702 | 43.2 | 0.95 | 83.3 | 0.689 |
| Contract age | ||||||
| Prior to 2006 | 32.7 | 39.3 | 79.4 | |||
| 2006–2013 | 25.3 | 0.156 | 50.9 | 0.039 | 95.2 | <0.001 |
| 2014–2019 | 35.0 | 0.808 | 41.3 | 0.847 | 61.5 | 0.019 |
| National | ||||||
| Single State | 36.5 | 43.5 | 83.8 | |||
| Multiple States | 26.7 | 0.045 | 42.8 | 0.902 | 82.7 | 0.789 |
| Profit | ||||||
| Non-profit | 42.2 | 43.2 | 95.2 | |||
| For-profit | 28.4 | 0.036 | 43.1 | 0.989 | 81.0 | 0.008 |
| Provider integration | ||||||
| Non-integrated | 30.5 | 43.1 | 83.2 | |||
| Integrated health system | 87.8 | < 0.001 | 89.4 | < 0.001 | 99.8 | < 0.001 |
| Contract penetration | ||||||
| 2.7 to 8.0% | 49.9 | 51 | 87.4 | |||
| 8.0 to 11.0% | 33.5 | 0.007 | 66.6 | 0.011 | 94.7 | 0.095 |
| 11.0 to 23.5% | 19.1 | < 0.001 | 29 | 0.001 | 96.2 | 0.063 |
| > 23.5% | 12.3 | < 0.001 | 11.6 | < 0.001 | 44.5 | < 0.001 |
| Primary Care | Psychiatry | Mental and Behavioral | ||||
| Enrollee characteristics | % Narrow | p value | % Narrow | p value | % Narrow | p value |
| Race/ethnicity | ||||||
| White | 22.8 | 32.3 | 79.4 | |||
| Black | 21.7 | 0.764 | 29.4 | 0.475 | 80.8 | 0.623 |
| Hispanic | 39.7 | 0.007 | 47.7 | 0.026 | 86.2 | 0.325 |
| Asian | 34.7 | 0.054 | 46.3 | 0.039 | 90.2 | 0.036 |
| NA/AI | 28.1 | 0.302 | 36.4 | 0.471 | 81.1 | 0.744 |
| Other | 26.5 | 0.037 | 36.8 | 0.042 | 83.9 | 0.02 |
| Gender | ||||||
| Female | 25.7 | 34.8 | 81.29 | |||
| Male | 25.1 | 0.133 | 34.2 | 0.238 | 80.68 | 0.401 |
| Age | ||||||
| Under 65 | 25.4 | 35.5 | 80.8 | |||
| Over 65 | 24.8 | 0.828 | 28.3 | 0.036 | 91.6 | 0.89 |
| Dual eligibility | ||||||
| Not dual | 23.8 | 34.9 | 79.8 | |||
| Dual | 30.9 | 0.106 | 32.9 | 0.716 | 85.3 | 0.414 |
Percentages are row percentages and represent the % of enrollees in a contract of a given type that are in a narrow network. Narrow networks are defined as those that include less than 25% of available providers of a type in a given contracts service area. Only HMOs and PPOs are included in this analysis. p values are calculated using univariate regressions. Provider specialties are defined by taxonomy codes. Mental and Behavioral includes providers such as counselors, psychologists, and social workers and does not include psychiatrists. Primary Care includes geriatricians. Pediatricians and pediatric specialists are excluded from each classification. Integrated health systems are excluded from each row with the exception of the integrated health system percentages as they differ substantially from other contracts. Providers included individual MDs, NPs, PA’s, psychologists, and others who are required to register for an NPI