What is it about?
The article is the first major examination of Medicare Advantage provider networks. It also incorporates provider quality into assessments of network adequacy. Using data from California cardiologists, endocrinologists, and obstetricians and gynecologists the paper finds that Medicare Advantage beneficiaries generally do well in large metropolitan areas. However, there are significant problems of beneficiaries in more rural parts of the state. Ultimate, the paper argues that understanding the connection between provider quality and networks requires an assessments of provider access.
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Why is it important?
There really is no work on Medicare Advantage provider networks and beneficiary access and our knowledge does not match the importance of the program. This article is the first assessment of access to specialists under Medicare Advantage, particularly with a focus on quality.
Perspectives
My work creates a better understanding of Medicare Advantage as well as raises questions about provider network regulation more generally and how it is connected to consumer access.
Dr Simon F Haeder
Texas A&M University College Station
Read the Original
This page is a summary of: Quality Regulation? Access to High-Quality Specialists for Medicare Advantage Beneficiaries in California, Health Services Research and Managerial Epidemiology, January 2019, SAGE Publications,
DOI: 10.1177/2333392818824472.
You can read the full text:
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