ACA plans likely to exclude top cancer hospitals

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 - Laura Yasaitis, PhD
Laura Yasaitis, PhD

Coverage on the Affordable Care Act (ACA) insurance exchanges, where narrow network plans are dominant, is more likely to exclude doctors associated with National Cancer Institute (NCI)-designated cancer centers, according to a new study published in the Journal of Clinical Oncology.

The study, led by Laura Yasaitis, PhD, a postdoctoral researcher at the University of Pennsylvania’s Perelman School of Medicine, examined the provider networks of plans offered on the exchanges in 2014, the first year the marketplace was open. It then assessed how often oncologists affiliated with NCI-designed centers or National Comprehensive Cancer Network (NCCN) cancer centers—both considered indicators of higher-quality care—were included in those networks.

Data on more than 23,000 oncologists were included in the study. More than 12,000, or 59.2 percent, were practicing in the 51 markets with at least one NCI-designated center, and nearly 8,000 were practicing in the 27 markets with centers also designated by the NCCN.

For the more than 11,000 oncologists not near a NCI-designated center, only 18 percent weren’t included in the network of at least one ACA exchange plan. The share was higher for oncologists near a NCI center (26.2 percent excluded from any ACA exchange) or near both a NCI and NCCN-designated center (25.3 percent).

“To see such a robust result was surprising,” Yasaitis said in a statement. “The finding that narrower networks were more likely to exclude NCI and NCCN oncologists was consistent no matter how we looked at it. This is not just a few networks. It’s a clear trend.”

Narrow network plans have become more prevalent as insurers seek ways to limit costs. While they may offer lower premiums, it can come at the expense of reducing access to higher-quality providers, the study authors wrote. An exception would be narrow networks tied to high-quality, integrated systems, with the authors singling out Kaiser Permanente as an example.

The solutions fall on the insurers, the study concluded, suggesting provider directories include quality designations, like being a NCI facility, as well as allowing patients to seek out-of-network care without having to pay full price in “exceptional circumstances.”

“If patients have narrow network plans and absolutely need the kind of complex cancer care that they can only receive from one of these providers, there should be a standard exception process to allow patients to access the care they need,” said study co-author Justin Bekelman, MD.