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Apr 22, 2015

Leading Cancer Centers May Be More Widely Included in Exchange Networks than Expected

A new survey conducted by Avalere and the National Comprehensive Cancer Network® (NCCN®) shows that exchange plan participation by the nation’s leading cancer centers is highly varied, but may be better than initial 2014 reports suggested.

Initiated in February 2015, the intent of the survey was to analyze experiences with healthcare exchanges and understand the scope of reportedly narrow networks, as reported by National Cancer Institute (NCI)-designated cancer centers. Surveys were distributed to individuals with titles of VP/Director of Payer or Managed Care Contracting (or similar) at 61 NCI-designated centers that treat patients. In total, 20 centers completed the survey across 19 states.

Specifically, 75 percent of cancer centers that responded indicate they are covered by at least some of the exchange plans offered by most of the carriers in their state. Among this group, 13 percent report they are covered by all the exchange plans in their state.

“With the majority of respondents reporting that they are in-network for exchange plans offered by most of the insurance carriers in their state, coverage of leading cancer centers in exchange plan networks appears better than what has been anecdotally reported,” said Sung Hee Choe, director at Avalere. “That said, 25 percent of centers still report they are excluded from the networks offered by most of their state's exchange carriers, indicating there are geographic pockets where access may be an issue.”

Half of centers report that individual exchange plans in their state have tiered provider networks with differential enrollee cost-sharing at each tier and most of the responding centers report that they fall in the higher tiers only. Still, the majority of centers indicate they are included in more or the same number of plans as 2014, which is also largely in line with their expectations. These results suggest that the picture of cancer center inclusion in exchange plan networks may not be as grim as feared when the exchange markets launched in late 2013. 1, 2, 3

Additionally, cancer centers report that reimbursement rates for exchange plans are generally in line with or slightly below commercial contracts, but are higher than Medicare and Medicaid rates. While some carriers may be extending commercial rates to exchange contracts, others appear to be seeking modest discounts from commercial payments.

“The findings challenge current market assumptions about the exclusion of prominent medical centers from exchange plans,” said Caroline Pearson, senior vice president at Avalere. “As plans continue to assess and refine their network designs it will be important to ensure that access is a key facet of the program.”

1. Somashekhar, S. and Cha, A. “Insurers Restricting Choice of Doctors and Hospitals to Keep Costs Down.” Washington Post. November 20, 2013.

2. Abelson, R. “More Insured, but the Choices Are Narrowing.” New York Times. May 12, 2014. 

3. “Narrow Networks and High Cost-Sharing Among Concerns Raised by New Report on Affordable Care Act.” The Leukemia & Lymphoma Society website. Accessed at: http://www.lls.org/aboutlls/news/newsreleases/011514_lls_milliman_study_results?version=1. on  April 15, 2015.

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