Research Overview

My research on network adequacy examines whether health insurance plans provide enrollees with meaningful access to healthcare providers. As insurers increasingly turn to narrow networks as a cost-containment strategy, questions arise about whether consumers can actually access the care promised by their insurance plans. A critical component of this challenge is provider directory accuracy. My research has consistently documented that provider directories contain extensive inaccuracies across all markets and specialties, with error rates ranging from 23% to over 50% depending on the market and specialty examined. These inaccuracies persist even in states with the nation's strongest regulatory protections, and often remain uncorrected for well over a year even after federal reforms like the No Surprises Act.

Through comprehensive analyses of provider networks in California, Pennsylvania, Maryland, and other states, I have documented that marketplace plan networks typically contain about half as many providers as commercial plans. More concerning, network designs often create what I term "artificial local provider deserts"—geographic areas within networks that are devoid of providers by design. My work incorporates consumer-focused attributes like travel distance and geographic accessibility to assess whether networks truly meet patients' needs. Even when provider directories are accurate, consumers face significant challenges scheduling timely appointments. For mental health care in particular, appointment availability remains severely limited despite federal and state parity requirements.

My research has shown that narrow networks are associated with 6-16% lower premiums, providing important cost benefits. However, network breadth alone is an insufficient measure of adequacy. Through analysis of state regulatory approaches and consumer preferences, I have found that effective network regulation must consider geographic distribution, specialty mix, appointment availability, and provider directory accuracy. A fundamental challenge is enforcement: even well-designed regulations prove ineffective without dedicated enforcement mechanisms and meaningful sanctions. My research comparing state regulatory approaches reveals wide variation in standards and enforcement, with most relying on complaint-based systems that favor more resourced consumers. This work has informed regulatory reforms in California and other states, and highlights the need for more sophisticated approaches to measuring and enforcing network adequacy standards that prioritize consumer access over administrative compliance.