Analysls of Lhe Cbamacare rovlder neLworks

8ronze versus Cold and launum lans

Pow rovlder neLworks vary As ?ou 8uy CosLller lans
Scou Coulleb, Mu
kelly 8. lunderburk
1he Amerlcan LnLerprlse lnsuLuLe
!anuary 20, 2014
Analysls of Lhe Cbamacare rovlder neLworks:
Pow rovlder neLworks vary As ?ou 8uy CosLller lans
Cur MeLhodology
We analyzed Lhe provlder neLworks avallable ln Lhe lowesL cosL bronze plans and
Lhe hlgher cosL gold plans oered by AnLhem 8lueCross 8lueShleld ln markeLs
where Lhe lnsurer oers boLh bronze and gold plans slde by slde.
Cur goal was Lo compare Lhe neLworks avallable ln Lhe bronze versus gold
oerlngs, Lo see lf Lhere was a dlerence ln Lhe slze of Lhe neLwork avallable Lo
consumers who purchased Lhe cosLller plans
ln addluon, we conducLed a slmllar analysls for Pumana plans across a selecLed
number of markeLs where Lhe lnsurer oers boLh bronze and plaunum plans.
Cnce agaln, our goal was Lo compare Lhe slze of Lhe provlder neLwork avallable
Lhrough Lhe low cosL bronze plan compared Lo Lhe provlder neLwork avallable ln
Lhe hlghesL cosL plaunum plan. Cur goal was Lo see lf Lhe slze of Lhe neLwork
lncreased as consumers spenL more premlum money Lo buy cosLller coverage.
Analysls of Lhe Cbamacare rovlder neLworks:
Pow rovlder neLworks vary As ?ou 8uy CosLller lans
Cur llndlngs
We found LhaL for bronze, gold, and plaunum plans oered by Lhe same lnsurer, ln Lhe
same markeL, Lhe provlder neLworks were ldenucal. ln mosL cases, Lhe drug formularles
were also ldenucal. 1here was no varlauon ln Lhe quallLy of Lhe neLworks or beneLs
when comparlng across Lhe dlerenL klnds of meLal opuons wlLhln a glven plan oerlng.
1hese comparlsons were for a glven qualled healLh plan producL. ln oLher words, Lhe
lack of varlauon was observed when you looked aL Lhe provlder neLworks for a glven
PMC or C producL, and compared Lhe bronze, gold, and plaunum plans across LhaL
parucular healLh plan oerlng. 1here was more varlauon when you compared beLween a
parucular lnsurers dlerenL producL Lypes (for example, a 8lue Cross 8lue Shleld PMC
compared Lo lLs C producL, or dlerenL PMC producLs compared Lo each oLher).
Powever, ln many markeLs, such a cholce of producLs does noL exlsL.
As a resulL, Lhe only maLerlal dlerence beLween dlerenL meLal opuons wlLhln Lhe same
plan, oered by Lhe same lnsurer, ln Lhe same markeL, was Lhe cosL sharlng sLrucLure. 8y
paylng hlgher premlums, consumers are able Lo reduce Lhe amounL of Lhelr ouL of pockeL
llablllues and lower Lhelr deducuble. ln eecL, you are fronung a hlgher premlum Lo buy
down your expecLed ouL of pockeL cosLs. 8uL you Lyplcally can'L geL access Lo a beuer
neLwork of provlders, or drug beneL, by chooslng a plaunum opuon over a bronze
opuon wlLhln a glven qualled healLh plan oered by an lnsurer ln each parucular markeL.
CardlologlsLs Avallable ln a 8ronze versus Cold lan
1he Lxperlence of AnLhem 8lueCross 8lueShleld
!"#"$ &'(" )'*+,'+( -'+."/ 0.
1#23 !$,$2"$4 !"#"$
-'+."/
)'*+,#5'.
6+78$9 ': -#940',';0("(
<.(+9$9=( >9'.?$ ),#.
6+78$9 ': -#940',';0("(
<.(+9$9=( @',4 ),#.
C1 lalreld 933,833 216 216
k? !eerson 730,828 194 194
nP Plllsborough 402,922 73 73
CC Ll aso 644,964 38 38
ln Marlon 918,977 74 74
ML Cumberland 283,921 48 48
nv Clark 2,000,739 100 100
CP Cuyahoga 1,263,111 260 260
Wl Mllwaukee 933,203 100 100
vA lalrfax 1,081,726 370 370
MC SL. Louls 318,172 99 99
uaLa ls for AnLhem 8lueCross 8lueShleld and compares Lhe lnsurers aLhway x" 8ronze plans oered ln Lhese markeLs wlLh lLs Cold
plan oered each markeL. We chose Lhe AnLhem plans because Lhey are generally consldered one of Lhe beuer lnsurance producLs
belng oered nauonally ln Lhe Cbamacare exchanges, Lhey operaLe plans ln many sLaLes, and Lhey provlde beuer Lransparency around
Lhelr plans Lhan many compeuLors - maklng comparlsons beLween Lhelr plans easler. We focused on Lhe mosL populous counLy ln each
sLaLe Lo provlde Lhe besL opporLunlLy for Lhe plan Lo have compeuuve access Lo a large number of provlders
!"#"$ &'(" )'*+,'+( -'+."/ 0.
1#23 !$,$2"$4 !"#"$
-'+."/
)'*+,#5'.
6+78$9 ': A.2',';0("(
<.(+9$9=( >9'.?$ ),#.
6+78$9 ': A.2',';0("(
<.(+9$9=( @',4 ),#.
C1 lalreld 933,833
33 33
k? !eerson 730,828
32 32
nP Plllsborough 402,922
14 14
CC Ll aso 644,964
22 22
ln Marlon 918,977
27 27
ML Cumberland 283,921
23 23
nv Clark 2,000,739
33 33
CP Cuyahoga 1,263,111
36 36
Wl Mllwaukee 933,203
97 97
vA lalrfax 1,081,726
19 19
MC SL. Louls 318,172
24 24
uaLa ls for AnLhem 8lueCross 8lueShleld and compares Lhe lnsurers aLhway x" 8ronze plans oered ln Lhese markeLs wlLh lLs Cold
plan oered each markeL. We chose Lhe AnLhem plans because Lhey are generally consldered one of Lhe beuer lnsurance producLs
belng oered nauonally ln Lhe Cbamacare exchanges, Lhey operaLe plans ln many sLaLes, and Lhey provlde beuer Lransparency around
Lhelr plans Lhan many compeuLors - maklng comparlsons beLween Lhelr plans easler. We focused on Lhe mosL populous counLy ln each
sLaLe Lo provlde Lhe besL opporLunlLy for Lhe plan Lo have compeuuve access Lo a large number of provlders
CncologlsLs Avallable ln a 8ronze versus Cold lan
1he Lxperlence of AnLhem 8lueCross 8lueShleld
!"#"$ &'(" )'*+,'+( -'+."/ 0.
1#23 !$,$2"$4 !"#"$
-'+."/
)'*+,#5'.
6+78$9 ': A9"3'*$40("(
<.(+9$9=( >9'.?$ ),#.
6+78$9 ': A9"3'*$40("(
<.(+9$9=( @',4 ),#.
C1 lalreld 933,833
93 93
k? !eerson 730,828
262 262
nP Plllsborough 402,922
93 93
CC Ll aso 644,964
42 42
ln Marlon 918,977
74 74
ML Cumberland 283,921
63 63
nv Clark 2,000,739
43 43
CP Cuyahoga 1,263,111
166 166
Wl Mllwaukee 933,203
139 139
vA lalrfax 1,081,726
143 143
MC SL. Louls 318,172
193 193
uaLa ls for AnLhem 8lueCross 8lueShleld and compares Lhe lnsurers aLhway x" 8ronze plans oered ln Lhese markeLs wlLh lLs Cold
plan oered each markeL. We chose Lhe AnLhem plans because Lhey are generally consldered one of Lhe beuer lnsurance producLs
belng oered nauonally ln Lhe Cbamacare exchanges, Lhey operaLe plans ln many sLaLes, and Lhey provlde beuer Lransparency around
Lhelr plans Lhan many compeuLors - maklng comparlsons beLween Lhelr plans easler. We focused on Lhe mosL populous counLy ln each
sLaLe Lo provlde Lhe besL opporLunlLy for Lhe plan Lo have compeuuve access Lo a large number of provlders
CrLhopedlsLs Avallable ln a 8ronze versus Cold lan
1he Lxperlence of AnLhem 8lueCross 8lueShleld
!"#"$ &'(" )'*+,'+( -'+."/ 0.
1#23 !$,$2"$4 !"#"$
-'+."/
)'*+,#5'.
6+78$9 ':
B$97#"',';0("(
<.(+9$9=( >9'.?$ ),#.
6+78$9 ':
B$97#"',';0("(
<.(+9$9=( @',4 ),#.
C1 lalreld 933,833
33 33
k? !eerson 730,828
104 104
nP Plllsborough 402,922
21 21
CC Ll aso 644,964
32 32
ln Marlon 918,977
34 34
ML Cumberland 283,921
17 17
nv Clark 2,000,739
39 39
CP Cuyahoga 1,263,111
90 90
Wl Mllwaukee 933,203
19 19
vA lalrfax 1,081,726
13 13
MC SL. Louls 318,172
18 18
uaLa ls for AnLhem 8lueCross 8lueShleld and compares Lhe lnsurers aLhway x" 8ronze plans oered ln Lhese markeLs wlLh lLs Cold
plan oered each markeL. We chose Lhe AnLhem plans because Lhey are generally consldered one of Lhe beuer lnsurance producLs
belng oered nauonally ln Lhe Cbamacare exchanges, Lhey operaLe plans ln many sLaLes, and Lhey provlde beuer Lransparency around
Lhelr plans Lhan many compeuLors - maklng comparlsons beLween Lhelr plans easler. We focused on Lhe mosL populous counLy ln each
sLaLe Lo provlde Lhe besL opporLunlLy for Lhe plan Lo have compeuuve access Lo a large number of provlders
uermaLologlsLs Avallable ln a 8ronze versus Cold lan
1he Lxperlence of AnLhem 8lueCross 8lueShleld
!"#"$ &'(" )'*+,'+( -'+."/ 0.
1#23 !$,$2"$4 !"#"$
-'+."/
)'*+,#5'.
6+78$9 ': A>C@D6(
<.(+9$9=( >9'.?$ ),#.
6+78$9 ': A>C@D6(
<.(+9$9=( @',4 ),#.
C1 lalreld 933,833
319 319
k? !eerson 730,828
328 328
nP Plllsborough 402,922
107 107
CC Ll aso 644,964
87 87
ln Marlon 918,977
98 98
ML Cumberland 283,921
60 60
nv Clark 2,000,739
118 118
CP Cuyahoga 1,263,111
189 189
Wl Mllwaukee 933,203
93 93
vA lalrfax 1,081,726
133 133
MC SL. Louls 318,172
132 132
uaLa ls for AnLhem 8lueCross 8lueShleld and compares Lhe lnsurers aLhway x" 8ronze plans oered ln Lhese markeLs wlLh lLs Cold
plan oered each markeL. We chose Lhe AnLhem plans because Lhey are generally consldered one of Lhe beuer lnsurance producLs
belng oered nauonally ln Lhe Cbamacare exchanges, Lhey operaLe plans ln many sLaLes, and Lhey provlde beuer Lransparency around
Lhelr plans Lhan many compeuLors - maklng comparlsons beLween Lhelr plans easler. We focused on Lhe mosL populous counLy ln each
sLaLe Lo provlde Lhe besL opporLunlLy for Lhe plan Lo have compeuuve access Lo a large number of provlders
CbsLeLrlcs-CynecologlsLs Avallable ln a 8ronze versus Cold lan
1he Lxperlence of AnLhem 8lueCross 8lueShleld
!"#"$ &'(" )'*+,'+( -'+."/ 0.
1#23 !$,$2"$4 !"#"$
-'+."/
)'*+,#5'.
6+78$9 ':
@#("9'$."$9',';0("(
<.(+9$9=( >9'.?$ ),#.
6+78$9 ':
@#("9'$."$9',';0("(
<.(+9$9=( @',4 ),#.
C1 lalreld 933,833
130 130
k? !eerson 730,828
93 93
nP Plllsborough 402,922
41 41
CC Ll aso 644,964
23 23
ln Marlon 918,977
71 71
ML Cumberland 283,921
29 29
nv Clark 2,000,739
17 17
CP Cuyahoga 1,263,111
134 134
Wl Mllwaukee 933,203
66 66
vA lalrfax 1,081,726
112 112
MC SL. Louls 318,172
30 30
uaLa ls for AnLhem 8lueCross 8lueShleld and compares Lhe lnsurers aLhway x" 8ronze plans oered ln Lhese markeLs wlLh lLs Cold
plan oered each markeL. We chose Lhe AnLhem plans because Lhey are generally consldered one of Lhe beuer lnsurance producLs
belng oered nauonally ln Lhe Cbamacare exchanges, Lhey operaLe plans ln many sLaLes, and Lhey provlde beuer Lransparency around
Lhelr plans Lhan many compeuLors - maklng comparlsons beLween Lhelr plans easler. We focused on Lhe mosL populous counLy ln each
sLaLe Lo provlde Lhe besL opporLunlLy for Lhe plan Lo have compeuuve access Lo a large number of provlders
CasLroenLerologlsLs Avallable ln a 8ronze versus Cold lan
1he Lxperlence of AnLhem 8lueCross 8lueShleld
!"#"$ &'(" )'*+,'+( -'+."/ 0.
1#23 !$,$2"$4 !"#"$
-'+."/
)'*+,#5'.
6+78$9 ': )$40#"9020#.(
<.(+9$9=( >9'.?$ ),#.
6+78$9 ': )$40#"9020#.(
<.(+9$9=( @',4 ),#.
C1 lalreld 933,833
443 443
k? !eerson 730,828
448 448
nP Plllsborough 402,922
177 177
CC Ll aso 644,964
122 122
ln Marlon 918,977
617 617
ML Cumberland 283,921
102 102
nv Clark 2,000,739
136 136
CP Cuyahoga 1,263,111
462 462
Wl Mllwaukee 933,203
124 124
vA lalrfax 1,081,726
409 409
MC SL. Louls 318,172
247 247
uaLa ls for AnLhem 8lueCross 8lueShleld and compares Lhe lnsurers aLhway x" 8ronze plans oered ln Lhese markeLs wlLh lLs Cold
plan oered each markeL. We chose Lhe AnLhem plans because Lhey are generally consldered one of Lhe beuer lnsurance producLs
belng oered nauonally ln Lhe Cbamacare exchanges, Lhey operaLe plans ln many sLaLes, and Lhey provlde beuer Lransparency around
Lhelr plans Lhan many compeuLors - maklng comparlsons beLween Lhelr plans easler. We focused on Lhe mosL populous counLy ln each
sLaLe Lo provlde Lhe besL opporLunlLy for Lhe plan Lo have compeuuve access Lo a large number of provlders
edlaLrlclans Avallable ln a 8ronze versus Cold lan
1he Lxperlence of AnLhem 8lueCross 8lueShleld
!"#"$ &'(" )'*+,'+( -'+."/ 0.
1#23 !$,$2"$4 !"#"$
-'+."/
)'*+,#5'.
6+78$9 ': )907#9/ -#9$
)3/(020#.(
<.(+9$9=( >9'.?$ ),#.
6+78$9 ': )907#9/ -#9$
)3/(020#.(
<.(+9$9=( @',4 ),#.
C1 lalreld 933,833
942 942
k? !eerson 730,828
788 788
nP Plllsborough 402,922
307 307
CC Ll aso 644,964
236 236
ln Marlon 918,977
1492 1492
ML Cumberland 283,921
233 233
nv Clark 2,000,739
260 260
CP Cuyahoga 1,263,111
697 697
Wl Mllwaukee 933,203
247 247
vA lalrfax 1,081,726
863 863
MC SL. Louls 318,172
477 477
uaLa ls for AnLhem 8lueCross 8lueShleld and compares Lhe lnsurers aLhway x" 8ronze plans oered ln Lhese markeLs wlLh lLs Cold
plan oered each markeL. We chose Lhe AnLhem plans because Lhey are generally consldered one of Lhe beuer lnsurance producLs
belng oered nauonally ln Lhe Cbamacare exchanges, Lhey operaLe plans ln many sLaLes, and Lhey provlde beuer Lransparency around
Lhelr plans Lhan many compeuLors - maklng comparlsons beLween Lhelr plans easler. We focused on Lhe mosL populous counLy ln each
sLaLe Lo provlde Lhe besL opporLunlLy for Lhe plan Lo have compeuuve access Lo a large number of provlders
rlmary Care hyslclans Avallable ln a 8ronze versus Cold lan
1he Lxperlence of AnLhem 8lueCross 8lueShleld
!"#"$ &'(" )'*+,'+( -'+."/ 0.
1#23 !$,$2"$4 !"#"$
-'+."/
)'*+,#5'.
6+78$9 ': @$.$9#,
)9#252$ )3/(020#.(
<.(+9$9=( >9'.?$ ),#.
6+78$9 ': @$.$9#,
)9#252$ )3/(020#.(
<.(+9$9=( ),#5.+7 ),#.
AL !eerson 660,009
367 367
AZ Marlcopa 3,942,169
191 191
lL Mlaml-uade 2,391,033
84 84
CA lulLon 977,773
21 21
lL Cook 3,231,331
210 210
Ml Wayne 1,792,363
69 69
MS Plnds 248,643
98 98
u1 SalL Lake 1,063,842
42 42
1x Parrls 4,233,700
187 187
Ceneral racuce hyslclans Avallable ln a 8ronze versus launum lan
1he Lxperlence of Pumana
We analyzed Lhe provlder neLworks avallable ln bronze versus plaunum plans oered by healLh lnsurer Pumana across nlne
selecLed markeLs where Pumana ls operaung boLh bronze and plaunum plans. We chose Pumana because Lhe lnsurer
operaLes ln many sLaLes, and has also chosen Lo operaLe plaunum plans ln many of Lhose markeLs.
!"#"$ &'(" )'*+,'+( -'+."/ 0.
1#23 !$,$2"$4 !"#"$
-'+."/
)'*+,#5'.
6+78$9 ': <."$9.0("(
<.(+9$9=( >9'.?$ ),#.
6+78$9 ': <."$9.0("(
<.(+9$9=( ),#5.+7 ),#.
AL !eerson 660,009
238 238
AZ Marlcopa 3,942,169
73 73
lL Mlaml-uade 2,391,033
129 129
CA lulLon 977,773
17 17
lL Cook 3,231,331
212 212
Ml Wayne 1,792,363
67 67
MS Plnds 248,643
30 30
u1 SalL Lake 1,063,842
41 41
1x Parrls 4,233,700
129 129
lnLernlsLs Avallable ln a 8ronze versus launum lan
1he Lxperlence of Pumana
We analyzed Lhe provlder neLworks avallable ln bronze versus plaunum plans oered by healLh lnsurer Pumana across nlne
selecLed markeLs where Pumana ls operaung boLh bronze and plaunum plans. We chose Pumana because Lhe lnsurer
operaLes ln many sLaLes, and has also chosen Lo operaLe plaunum plans ln many of Lhose markeLs.
!"#"$ &'(" )'*+,'+( -'+."/ 0.
1#23 !$,$2"$4 !"#"$
-'+."/
)'*+,#5'.
6+78$9 ': )$40#"9020#.(
<.(+9$9=( >9'.?$ ),#.
6+78$9 ': )$40#"9020#.(
<.(+9$9=( ),#5.+7 ),#.
AL !eerson 660,009
137 137
AZ Marlcopa 3,942,169
33 33
lL Mlaml-uade 2,391,033
78 78
CA lulLon 977,773
1 1
lL Cook 3,231,331
98 98
Ml Wayne 1,792,363
106 106
MS Plnds 248,643
73 73
u1 SalL Lake 1,063,842
11 11
1x Parrls 4,233,700
103 103
edlaLrlclans Avallable ln a 8ronze versus launum lan
1he Lxperlence of Pumana
We analyzed Lhe provlder neLworks avallable ln bronze versus plaunum plans oered by healLh lnsurer Pumana across nlne
selecLed markeLs where Pumana ls operaung boLh bronze and plaunum plans. We chose Pumana because Lhe lnsurer
operaLes ln many sLaLes, and has also chosen Lo operaLe plaunum plans ln many of Lhose markeLs.
!"#"$ &'(" )'*+,'+( -'+."/ 0.
1#23 !$,$2"$4 !"#"$
-'+."/
)'*+,#5'.
6+78$9 ': -#940',';0("(
<.(+9$9=( >9'.?$ ),#.
6+78$9 ': -#940',';0("(
<.(+9$9=( ),#5.+7 ),#.
AL !eerson 660,009
243 243
AZ Marlcopa 3,942,169
196 196
lL Mlaml-uade 2,391,033
143 143
CA lulLon 977,773
39 39
lL Cook 3,231,331
233 233
Ml Wayne 1,792,363
63 63
MS Plnds 248,643
38 38
u1 SalL Lake 1,063,842
23 23
1x Parrls 4,233,700
131 131
CardlologlsLs Avallable ln a 8ronze versus launum lan
1he Lxperlence of Pumana
We analyzed Lhe provlder neLworks avallable ln bronze versus plaunum plans oered by healLh lnsurer Pumana across nlne
selecLed markeLs where Pumana ls operaung boLh bronze and plaunum plans. We chose Pumana because Lhe lnsurer
operaLes ln many sLaLes, and has also chosen Lo operaLe plaunum plans ln many of Lhose markeLs.
!"#"$ &'(" )'*+,'+( -'+."/ 0.
1#23 !$,$2"$4 !"#"$
-'+."/
)'*+,#5'.
6+78$9 ': A>C@D6(
<.(+9$9=( >9'.?$ ),#.
6+78$9 ': A>C@D6(
<.(+9$9=( ),#5.+7 ),#.
AL !eerson 660,009
91 91
AZ Marlcopa 3,942,169
139 139
lL Mlaml-uade 2,391,033
163 163
CA lulLon 977,773
170 170
lL Cook 3,231,331
206 206
Ml Wayne 1,792,363
84 84
MS Plnds 248,643
39 39
u1 SalL Lake 1,063,842
36 36
1x Parrls 4,233,700
143 143
CbsLeLrlclans/CynecologlsLs Avallable ln a 8ronze versus launum
lan
1he Lxperlence of Pumana
We analyzed Lhe provlder neLworks avallable ln bronze versus plaunum plans oered by healLh lnsurer Pumana across nlne
selecLed markeLs where Pumana ls operaung boLh bronze and plaunum plans. We chose Pumana because Lhe lnsurer
operaLes ln many sLaLes, and has also chosen Lo operaLe plaunum plans ln many of Lhose markeLs.