Most Federal Exchange Plans Under Affordable Care Act Do Not Contain NCI-Designated Cancer Center


Key Points

  • Nearly all federal exchange plans included a Commission on Cancer–accredited hospital.
  • Less than half of these plans included a National Cancer Institute–designated cancer center.

In a study reported in the Journal of Clinical Oncology, Kehl et al found that most federal exchange networks under the Affordable Care Act contain a Commission on Cancer–accredited hospital, but less than half contain a National Cancer Institute (NCI)-designated cancer center.

Study Details

The study involved use of publicly available machine-readable network data and public use files for individual federal exchange plans from the Centers for Medicare and Medicaid Services for the 2016 enrollment year, with these data being linked to National Provider Identifier data. A total of 4,058 unique individual plans were identified, with network data available for 3,637 (90%) and hospital information available for 3,531 (87%); the provider lists for these plans were reducible to 295 unique networks.

Inclusion of Accredited Hospitals

Among these networks, 95% included at least one Commission on Cancer–accredited hospital, and 41% included an NCI-designated center. Among 71 networks with plans advertising a national network, 99% contained a Commission on Cancer–accredited hospital, and 51% contained an NCI-designated cancer center. Among 224 plans without a national network designation, 93% contained a Commission on Cancer–accredited hospital, and 38% contained an NCI-designated center.

Overall, 92% of networks were linked to plans of only one network type (ie, point-of-service, exclusive provider organization [EPO], preferred provider organization [PPO], or health maintenance organization [HMO]). Among these networks, inclusion of Commission on Cancer–accredited hospitals ranged from 91% for HMOs to 100% for EPOs, and inclusion of NCI-designated cancer centers ranged from 31% for HMOs to 49% for PPOs (P = .04). There was no significant variation among the proportion of networks that included NCI-accredited centers according to plan metal level. There was substantial variation of proportion of networks within both states and counties that included NCI-designated centers (range = 0%–100%).

The investigators concluded: “A large majority of federal exchange networks contain [Commission on Cancer–]accredited hospitals, but most do not contain NCI-designated cancer centers. These results will inform policy regarding access to cancer care, and they reinforce the importance of promoting access to clinical trials and specialized care through community sites.”

Kenneth L. Kehl, MD, of The University of Texas MD Anderson Cancer Center, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.