Employers are turning towards health plans with limited provider networks to combat increasing health care costs. Some new enrollees of these plans will switch their usual primary care providers due to network restrictions leading to interruptions in continuity-of-care and potentially higher medical expenditures and/or lower quality care when compared to enrollees whose providers remain in-network. In this study, I analyzed the effects of switching primary care clinics on costs, utilization, and quality of care after enrollment in a limited network plan. The study setting was the employee benefits plan of the University of Minnesota, where after changes to the menu of its health plans in 2012, 4% (1,151 of 26,345) of covered adult lives enrolled in a limited network plan and subsequently switched primary care clinics. I answered three questions pertaining to enrollment in the limited network plan: 1) did individuals who switched primary care clinics have higher costs or more utilization compared to individuals who kept their clinics 2) did individuals who switched clinics switch to higher or lower quality clinics, and 3) what were the associations between clinic attributes and the clinic choices of enrollees who switched clinics? Switching primary care clinics was not associated with an increase in expenditures or the probabilities of having a hospitalization or an emergency department visit. However, switching primary care clinics was associated with approximately 1 additional primary care visit in the following year for enrollees in the sickest health risk quartile and approximately 0.5 fewer specialty care visits for enrollees in the three sickest health risk quartiles. The decreased utilization of specialty care is a potential negative implication of limited network plans as patients can receive higher quality care from specialty care providers on some conditions including diabetes and asthma. Furthermore, enrollees who switched primary care clinics obtained care at clinics with lower performance on clinical and behavioral quality as well as patient experience than if they had been able to keep their previous clinics. However, these differences were relatively small, with the exception of a 5.4 percentage point decrease in performance regarding patients’ satisfaction with timeliness of care. Of enrollees who switched primary care clinics, distance, payor mix, and the percent of specialty physicians had the largest effects on their choices. Quality had little association with primary care clinic choice. Given that the primary care clinic exclusions of the limited network plan did not have a substantial impact on the average performance of clinics available, these results suggest that enrollees did not emphasize quality of care when choosing primary care clinics. Overall, these results imply that employers offering limited network plans may be unlikely to face higher financial costs associated with enrollees switching primary care providers, although for individuals who would have to switch clinics, enrollment may not be appropriate if they are in need of timely specialty care.
University of Minnesota Ph.D. dissertation.August 2016. Major: Health Services Research, Policy and Administration. Advisor: Jon Christianson. 1 computer file (PDF); x, 147 pages.
Primary Care Clinic Switching Due to Provider Network Restrictions: Effects on Costs, Utilization, and Quality.
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