Restrictiveness of Medicare Advantage provider networks across physician specialties.

Objective: The objective was to measure specialty provider networks in Medicare Advantage (MA) and examine associations with market factors.

Data Sources And Study Setting: We relied on traditional Medicare (TM) and MA prescription drug event data from 2011 to 2017 for all Medicare beneficiaries in the United States as well as data from the Area Health Resources File.

Study Design: Relying on a recently developed and validated prediction model, we calculated the provider network restrictiveness of MA contracts for nine high-prescribing specialties.

Potential inequities in access to in-person SHIP counseling services.

Objectives: Counseling and education on Medicare coverage options are available through the federal State Health Insurance Assistance Program (SHIP), but little is known about the population that SHIP reaches.

Study Design: Cross-sectional study.

Methods: Using a novel data source on SHIP counseling site locations, we characterized the availability of in-person SHIP counseling by zip code tabulation area (ZCTA) and used linear regression and t tests to evaluate whether SHIP counseling sites are disproportionately located in higher-income communities.

Developing network adequacy standards for VA Community Care.

Objectives: To inform how the VA should develop and implement network adequacy standards, we convened an expert panel to discuss Community Care Network (CCN) adequacy and how VA might implement network adequacy standards for community care.

Data Sources/study Setting: Data were generated from expert panel ratings and from an audio-recorded expert panel meeting conducted in Arlington, Virginia, in October 2017.

Study Design: We used a modified Delphi panel process involving one round of expert panel ratings provided by nine experts in network adequacy standards.

Improving provider directory accuracy: can machine-readable directories help?

Objectives: To examine inaccuracies in health plan provider directories and consider whether the machine-readable (MR) formats required of provider directories in the health insurance exchanges are more accurate than conventional directories and have the potential to improve directory accuracy in the future.

Study Design: The descriptive study design included qualitative data collection through stakeholder interviews and quantitative data analysis and verification of provider data source accuracy from multiple sources.

Methods: Four separate sources of provider data from 5 counties were captured and aggregated into an analytic database.

Primary Care Physician Networks In Medicare Advantage.

Medicare Advantage (MA) plans often establish restrictive networks of covered providers. Some policy makers have raised concerns that networks may have become excessively restrictive over time, potentially interfering with patients' access to providers. Because of data limitations, little is known about the breadth of MA networks.

Too Early to Cut Transportation Benefits From Medicaid Enrollees.

Some state governments are considering cuts to the non-emergency medical transportation (NEMT) benefit for Medicaid enrollees, and some Federal officials have proposed making this easier. Yet, there is clear demand. In 2015 alone, low-income patients used 59 million rides for medical appointments.