Narrow Networks and Provider Quality: Is Choice Overrated?

Good health insurance must give patients access to good hospitals and doctors. Narrow networks can pass that test.

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To minimize costs, many health plans on the ACA-mandated insurance exchanges offer consumers only limited choices of hospitals and doctors. These so-called narrow networks have added controversy to a controversial law.

In a New York Times Op-Ed, Ezekiel Emanuel, who advised the Obama administration on drafting the law, argues that attention focused on the size of a plan's provider network is misplaced. The quality of the doctors and hospitals is what matters. He suggests that an organization with experience evaluating health care quality should develop a grading system for these networks. Oddly, he dismisses the only group already doing it: us.

U.S. News has been gathering and analyzing relevant health data for more than 20 years, including an evolving model to rate health insurance plans. So far, for example, we know that the narrower networks in California are less likely to include hospitals that excel on the kind of quality measures, such as patient safety scores, that underpin the U.S. News hospital rankings. Yet there are exceptions, which underscores that narrowness should not necessarily be equated with poor quality. 

We know that much of the insurance network data in the public domain is limited and unreliable. But in time, we expect to obtain better network data -- and to add it to our existing ratings of health plans. That will help millions of consumers make more informed decisions about which insurance plan to purchase. We're not the only ones who can or should be doing this, but so far, we're the only ones who are.