The size of insurers’ provider networks has been a headline grabber for the last few years, and there are some nascent efforts underway to make it easier to compare plans based on network size. Obviously, it’s in consumers’ best interest to search for specific providers if that’s a factor in their decision-making process, but what if we want to see how network sizes compare in a certain region?
I’m experimenting with developing a consistent rating system. Below are my results of taking the unique “IndividualProviders” and summing the unique “Facilities&Pharmacies” from the “DATA_ECP_NETWORK_ADEQUACY” file in the SERFF Health Plan Binders. The results are a little surprising, because I didn’t think Kaiser would have such a high rating. No method will be perfect, but please provide any feedback, ideas, or criticism of the methodology below.
Statewide Results
Colorado Totals By Carrier
Anthem BCBS 15,689
Bright 7,509
Cigna 13,551
Colorado Choice 5,713
Denver Health 860
Kaiser 13,392
RMHP 11,673
Per Carrier Breakdown
Anthem BCBS has 14,610 unique providers in Colorado
Anthem BCBS has 1,079 unique facilities in Colorado
Anthem BCBS has 15,689 total unique providers + facilities in Colorado
Bright has 6,614 unique providers in Colorado
Bright has 895 unique facilities in Colorado
Bright has 7,509 total unique providers + facilities in Colorado
Cigna has 11279 unique providers in Colorado
Cigna has 2272 unique facilities in Colorado
Cigna has 13551 total unique providers + facilities in Colorado
Colorado Choice has 5,225 unique providers in Colorado
Colorado Choice has 488 unique facilities in Colorado
Colorado Choice has 5,713 total unique providers + facilities in Colorado
Denver Health has 27 unique providers in Colorado
Denver Health has 833 unique facilities in Colorado
Denver Health has 860 total unique providers + facilities in Colorado
Kaiser has 12,754 unique providers in Colorado
Kaiser has 638 unique facilities in Colorado
Kaiser has 13,392 total unique providers + facilities in Colorado
RMHP has 10,038 unique providers in Colorado
RMHP has 1,635 unique facilities in Colorado
RMHP has 11,673 total unique providers + facilities in Colorado
ProFac Rating For Each Colorado County
Adams County (Arvada (part), Aurora (part), Brighton (part), Commerce City, Federal Heights, Northglenn, Strasburg (part), Thornton, Westminster (part))
Download “DATA_ECP_NETWORK_ADEQUACY” file in the SERFF Health Plan Binder for each carrier and title them “Carrier_Name.xlsm” (with underscores for spaces)
I developed this simple python script to count the unique “IndividualProviders1” and unique “Facilities&Pharmacies1”, based on National Producer Number (NPI). Finally, it sums those two numbers. The script will output the text and bar plot you see above.
Jay operates a health insurance brokerage in Colorado, where he helps individuals and small groups obtain and maintain health insurance coverage, provides data analysis, and creates visualizations that are easily understood by consumers and other stakeholders in Colorado’s health insurance market.
