# Implications of Provider Network Design for Access, Affordability and Competition in Health Insurance

> **NIH AHRQ R01** · VANDERBILT UNIVERSITY MEDICAL CENTER · 2020 · $357,173

## Abstract

Implications of Provider Network Design for Access, Affordability and Competition in Health Insurance
Abstract
Insurers have increasingly adopted restricted provider network insurance designs in response to rising health
costs and to regulatory mandates on the scope and generosity of private insurance plans. Restricted network
plans aim to lower premiums and other plan costs by limiting in-network services to a narrow set of (often low-
cost) providers, or through the adoption of tiered networks that encourage use of preferred (lower-cost)
facilities and providers. These plan designs have proliferated in recent years: over half of 2015 Affordable Care
Act marketplace plans had narrow hospital networks (i.e., fewer than 30% of local hospitals), and one-third of
large employer plans had at least one alternative tiered and/or narrow network offering in 2015. While these
plan designs have been shown to lower costs, they have also raised concerns over patient access to care and
whether such plans compromise affordability of care for patients who wish to maintain their current providers
when they switch insurance plans. Research on insurers' provider networks has been quite limited, however,
due to well-known inaccuracies and delays in provider network reporting on individual insurers' websites or in
plan brochures. This project will overcome these limitations by drawing on novel cleaned and harmonized data
on provider networks across a variety of markets (nongroup, employer, Medicare and Medicaid) in all 50
states. We will link these data with a variety of other data sources to execute a project that examines (Aim 1)
the relationship between provider network breadth and measures of insurer and provider market concentration
and consolidation; (Aim 2) the connectivity of provider networks across insurers and providers within market
segments, and across market segments; (Aim 3) the quality and characteristics of in-network providers in
narrow and tiered network plans; and (Aim 4) how plan networks adapt to local market changes (i.e., whether
plans strategically reshape their provider networks to avoid high-cost patients when a competing plan leaves
the market). Our project will inform not only scientific understanding of the role of provider networks in
insurance design, access and affordability, but also will provide key insights for policymakers and regulators
interested more efficient approaches to provider network oversight.

## Key facts

- **NIH application ID:** 9982268
- **Project number:** 5R01HS025976-03
- **Recipient organization:** VANDERBILT UNIVERSITY MEDICAL CENTER
- **Principal Investigator:** John A. Graves
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $357,173
- **Award type:** 5
- **Project period:** 2018-09-30 → 2022-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9982268

## Citation

> US National Institutes of Health, RePORTER application 9982268, Implications of Provider Network Design for Access, Affordability and Competition in Health Insurance (5R01HS025976-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9982268. Licensed CC0.

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