A Tale of Two Programs: Access to High Quality Providers for Medicare Advantage and Affordable Care Act Beneficiaries in New York State

Medicare Advantage and the Affordable Care Act's insurance marketplaces provide coverage to millions of beneficiaries. This paper assesses network design and access to percutaneous coronary intervention (PCI or angioplasty with stent) in New York for both programs. A specific focus is on access to higher quality providers. The findings indicate that both programs significantly restricted access and choice as compared to an unconstrained network. However, network design only rarely created areas devoid of any providers. In terms of access to quality, both programs tended to have slightly worse mean and median quality ratings than the overall physician supply. Findings with regard to access to above-average providers were mixed. With respect to access to the highest quality providers, both ACA and Medicare Advantage plans generally fared slightly worse than unrestricted networks. In micropolitan and rural areas, access issues became apparent. Network regulation may do little to address these concerns. However, adding non-emergency medical transportation benefits to insurance coverage may prove to be desirable going forward.