Effects of Tiered Physician Networks on Health Care Use and Provider Behavior

This study will use data from the Massachusetts Group Insurance Commission to (1) quantify the system-wide effects of tiered network benefit designs on referrals, hospital choice, health care use and spending, and (2) assess how these impacts vary with the design of the tiered networks, urban/rural market location and the competitiveness of the local physician market. Different tiered network designs to be studied include the size of the relative copayment differentials across tiers, tiering at the level of the physician group vs. individual physician, and whether tiering includes primary care physicians as well as specialists. Findings can inform the design and implementation of tiered networks and enhance understanding of the market conditions that may facilitate or inhibit impact.