Conducting a 'secret shopper' survey to understand the impact of network inadequacy on beneficiary access to Medicaid managed care plans

The Foundation's Network Design and Usability initiative was designed to explore the impact of health plans' network designs and policies on consumers' ability to use their health coverage.This project will use a 'secret shopper' survey to examine Medicaid managed care organization (MCO) enrollees' experience in searching for and securing outpatient appointments in their plan's clinician network. Today, most Medicaid beneficiaries are required to enroll in an MCO to receive health benefits and must navigate the network constraints and utilization controls of health plans to access health services. Whether plans build and maintain adequate provider networks is, therefore, a critical factor in determining whether MCO enrollees get the care they need without incurring unaffordable out-of-network charges. Deliverables from this project, including presentations to policymakers and publication manuscripts, will help state policymakers and others determine whether additional regulatory requirements or other policy or program changes could improve Medicaid enrollees' access to covered care.