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Evaluation of Minnesota health insurance network adequacy

This study assesses the adequacy of health insurance networks in Minnesota, focusing on specific provider specialties and types. Findings show network insufficiencies, raising concerns for patient access. Recommendations include improving network requirements and auditing carriers. Future research could explore dental providers and other specialties.

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Evaluation of Minnesota health insurance network adequacy

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  1. Evaluation of Minnesota health insurance network adequacy Jil Pavagadhi & Jennifer Schultz

  2. Background • US spends 17% of the GDP on health care, approximately $3 trillion • Minnesota spent about $39.8 billion in 2012 (MN Dept. of Health) • Access is limited to persons with • Insurance through employer/ exchange • Government sponsored program • Private insurance/ care • Safety-net provider

  3. Background • Narrow Network plans are becoming popular (50% of marketplace offerings) • Drive down overall cost of healthcare • Lower premiums • Plans too narrow to offer care in a timely manner with additional issues (22%) • Decreasing over time (2015- 15 Networks  2017- 12 Networks) • Minnesota geographic access standards • 30 minutes/miles for primary care, mental health, & general hospital services • Waiver

  4. Research Objective • To evaluate the health insurance network adequacy in Minnesota for specific “Provider Specialties” (child psychiatry, psychiatry, neuropsychology, mental health nurse practioner & mental health clinical nurse specialist ) and several “Provider Types” (licensed independent clinical social worker, licensed psychologist, licensed professional clinical counselor (LPCC), chemical dependency provider- inpatient/outpatient). • The results will provide information to MN agencies & legislatures

  5. Approach • Data standardization and analysis • 37 insurance plans offered in 2017 • Excel • Mapped and drew out 30 min/mile polygons • 700- 78,000 provider locations per plan • With about 98-100% precision • ArcGIS

  6. Results • ~41% of plans are insufficient (15/37) • HealthPartners, Medica, Sandford Health • Most of them had spec 21 and 81 not available

  7. maps

  8. Conclusion • First time, cross checked by a third party • Network inadequacy clearly visible • Concern for patients and families with out adequate access to care • Networks are becoming more narrow • Possible reasons: • Insufficient mental health providers in Minnesota? • Plans are not adequately reimbursing providersand thus providers are not participating in networks.

  9. Future Work • Dental providers • Other specialty & provider types • Improve network adequacy requirements • Audit carriers • What specialty or provider type do you recommend researching next?

  10. References • http://www.health.state.mn.us/divs/hpsc/hep/publications/costs/healthspending2014.pdf • http://www.health.state.mn.us/divs/hpsc/mcs/networkadequacy.htm • http://www.ncsl.org/research/health/insurance-carriers-and-access-to-healthcare-providers-network-adequacy.aspx • http://www.house.leg.state.mn.us/comm/docs/cf5f0d04-f6e5-449c-9533-402bd2a20256.pdf

  11. THANK YOU!

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