Colorado Individual Market Network Size Rating Based on SERFF Data

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.

Colorado Health Insurance Network Size ProFac Rating

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

Scientific Methodology:

  • 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’ve made the excel files I used available here.)
  • 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.
  • Here is the script for the county level analysis.

Note that Cigna will be dropping the Vantage network in 2018, so it will be interesting to see how that affects their rating.

About Jay Norris

I'm a python developer and data scientist with a major interest in health care and risk management. I developed an interest in the Colorado health insurance industry by repeatedly injuring myself and dealing with incorrect health insurance claim service from the insurance company. Louise and I have two boys. My primary activities currently include skateboarding, data science, martial arts, gardening, and hiking/biking with my family.

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