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Using social-network analysis to understand insurance-network adequacy


Section of a large-scale social-network representation.

A HealthAffairs blog urges policymakers  needing to create and update rules for health-insurance-network adequacy to look at the tools of social-network analysis for guidance.

Social-network analysis studies the structure of relationships that link individuals or organizations. After all, network adequacy is not only about which providers are  in a health plan, but how they relate to  each another.

Looking at how often providers in a network share patients might be an important  marketing consideration for patients who value coordinated care. The HealthAffairs piece says that policymakers could use historical health plan claims data supplemented with Medicare fee-for-service claims to determine this frequency. Of course just because providers share patients doesn’t necessarily mean that they’re good at coordinating care.

Regulators can also use years of provider network data to  track changes in a plan’s outpatient provider networks to determine the average turnover rate per plan  overall and by specialty.



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