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. RESULTS: Our sample included 1511 SHIP counseling sites. More than half (63%) of the localities in our sample have a SHIP site within the ZCTA or county. Twenty-four percent do not have a SHIP site within the county but have one in an adjacent county. The remaining 13% do not have a nearby SHIP site. There is a disproportionate number of individuals eligible for Medicare in localities without a SHIP site. Moreover, the population living in areas without in-person SHIP sites is more likely to have low income and fewer years of education than the population living in areas with a SHIP site. CONCLUSIONS: These results suggest that there are areas where in-person SHIP service expansion or other additional navigation support may be warranted.

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. Provider data were analyzed through text matching techniques and provider practice phone interviews. Additionally, we interviewed 21 stakeholders. RESULTS: In quantitative analysis, we found widespread inaccuracy in provider information across directory types. Provider directory phone numbers were more likely to align with Google data than with the directory for the same company's health plans in other markets. It is vastly less expensive to aggregate data from MR files than from conventional directories, which suggests that MR files have potential to be cost-effectively leveraged for data quality improvements. In qualitative analysis, we found that interviewees perceived provider directories as inaccurate, but they differed in their perceptions of the severity of the problem. Interviewees who were familiar with MR directories understood their advantages over conventional directories. CONCLUSIONS: The MR provider directories are not more accurate than the conventional provider directories. However, there is strong reason to believe that MR technology can be leveraged to increase accuracy. Promising state- and vendor-led initiatives also have the potential to correct widespread provider directory inaccuracy.

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. Taking a novel approach, we used Medicare Part D claims data for 2011-15 to examine how primary care physician networks have changed over time and what demographic and plan characteristics are associated with varying levels of network breadth. Our findings indicate that the share of MA plans with broad networks increased from 80.1 percent in 2011 to 82.5 percent in 2015. Enrollment in broad-network plans grew from 54.1 percent to 64.9 percent over the same period. In an adjusted analysis, we detected no significant time trend. In addition, narrow networks were associated with urbanicity, higher income, higher physician density, and more competition among plans. Health maintenance organizations had narrower networks than did point-of-service plans, whose networks were narrower than those of preferred provider organizations.

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. NEMT's future is under threat because evidence that NEMT improves health care access and downstream outcomes is incomplete. Second, it remains largely unknown whether scarce public resources for transportation are being driven to those who benefit from its availability. This knowledge gap is answerable but unknown because of variations in how states administer NEMT. As a result, tracking who uses the services is inconsistent, and states are unable to link NEMT data with health care outcomes. Instead of cutting NEMT benefits, we believe an alternative path involves improved tracking and evaluations of the benefit first. Better informed policy decisions are needed. Otherwise, if policymakers implement blanket reductions in NEMT spending, they run the risk of causing more harm than good.