Study Reveals Need for Insurer Transparency, Greater Access for Patients With Cancer

Narrow insurance coverage has forced some patients to choose between lower premium plans and access to better quality cancer care, according to a recent report. These narrow insurance plans often exclude doctors that are associated with National Cancer Institute (NCI)-Designated Cancer Centers. However, the study authors argued that patients should have the opportunity to learn whether cancer care providers with certain affiliations are involved in narrow provider networks.

The study, published in the Journal of Clinical Oncology, investigated the cancer provider networks on 2014 individual health insurance exchanges, in order to identify which oncologists were affiliated with NCI-Designated Cancer Centers or National Comprehensive Cancer Network (NCCN) Cancer Centers. Both types of centers are known for high quality care and low mortality rates.

"Because cancer care and monitoring is costly, there are strong incentives for insurers to be selective when it comes to oncologists, excluding those who are most likely to attract the most complex and expensive cases," said lead author Laura Yasaitis, PhD, of the University of Pennsylvania’s Leonard Davis Institute of Health Economics, in a press release announcing the findings.

The researchers found that narrow networks were less likely to include doctors that were affiliated with NCI-Designated and NCCN Cancer Centers. The networks that did not have any physicians associated with an NCI center (33 of the 248 in the analysis) were found to be narrower on average. There was also a correlation between oncology network breadth and the relative inclusion of oncologists associated with NCI centers.

"Consumers may benefit financially from the fact that these narrow networks generally have lower premiums, but they may face reduced access to the higher-quality providers in their market," said co-senior author Daniel Polsky, PhD, executive director of the Leonard Davis Institute, in the press statement.

According to the study, in order to eliminate the need for patients to choose between high quality care and low premiums, greater transparency is needed. Health insurers, state regulators, and federal lawmakers need to educate patients about the affiliations of cancer care providers so consumers can make informed decisions when they are considering narrow health plans. That way, patients can receive care without encountering unknown penalties and consequences.

"If patients have narrow network plans and absolutely need the kind of complex cancer care that they can only receive from one of these providers, there should be a standard exception process to allow patients to access the care they need," said co-senior author Justin E. Bekelman, MD, associate professor of Radiation Oncology and Medical Ethics and Health Policy at Penn and senior fellow at the Leonard Davis Institute.