Variations in Patient Response to Tiered Physician Networks

American Journal of Managed Care
Vol. 22, No. 6
June 2016
Sinaiko, A.D.

Tiered physician networks are a managed care network design used by payers to contain health care costs and improve value in the health care system. Prior studies found that tiered provider networks channel patients to preferred providers in certain contexts. In this HCFO-funded study, the researchers analyzed data from five commercial health plans in Massachusetts to test whether the impact of tiered physician networks varies across different groups of patients. The researchers found that patients' loyalty to their own physicians is pervasive, and physicians with the worst tier rankings lost market share among new older, sicker patients. These findings suggest that tiered network designs have promise as one of a set of mechanisms to increase the value of health care spending.

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