JAMA Forum: What Do Medicare Advantage Networks Look Like?

Networks, and their narrowness, seems like a significant concern. Yet we know next to nothing about Medicare Advantage networks. That’s not so good. More about that in my latest JAMA Forum post.

In the absence of more comprehensive analysis, we should not be reassured that regulators are managing Medicare Advantage networks for quality and efficiency. Although the Centers for Medicare & Medicaid Services (CMS) imposes adequacy requirements based on time and distance criteria for Medicare Advantage physician networks, those requirements are routinely applied only when plans enter markets, and it remains unknown whether the criteria are met months and years after market entry. Indeed, in a 2015 report, the Government Accountability Office recommended more periodic reviews and verification of availability of physicians and hospitals within networks. Earlier this year the Department of Justice reached a settlement with 2 Medicare Advantage plans over charges of misrepresentation of their networks to regulators.



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