Journal of General Internal Medicine

, Volume 26, Issue 4, pp 440–445 | Cite as

The Impact of Health Plan Physician-Tiering on Access to Care

  • Sean Tackett
  • Chuck Stelzner
  • Elizabeth McGlynn
  • Ateev Mehrotra
Health Policy



In an attempt to improve quality and control costs, health plans are creating tiered products that encourage enrollees to seek care from “high-value” physicians. However, tiered products may limit access to care because patients may have to travel unreasonable distances to visit the nearest high-value physician.


To assess geographic access to high-value physicians, particularly for disadvantaged populations.


Cross-sectional observational study.


Physicians and adult patients in Massachusetts.


Travel time from census block centroid to nearest physician address under two scenarios: patients can see (1) any physician or (2) only high-value physicians.


Among the physicians, 768 (20.9%) primary care physicians (PCPs), 225 (26.6%) obstetricians/gynecologists, 69 (10.3%) cardiologists, and 31 (6.0%) general surgeons met the definition of high-value. Statewide mean travel times to the nearest PCP, obstetrician/gynecologist, cardiologist, or general surgeon under the two scenarios (any physician vs. only high-value physicians) were 2.8 vs. 4.8, 6.0 vs. 7.2, 7.0 vs. 12.4, and 6.6 vs. 14.8 minutes, respectively. Across the four specialties, between 89.4%–99.4% of the population lived within 30 minutes of the nearest high-value physician. Rural populations had considerably longer travel times to see high-value physicians, but other disadvantaged populations generally had shorter travel times than comparison groups.


Most patients in Massachusetts are likely to have reasonable geographic access to high-value physicians in tiered health plans. However, local demographics, especially rural residence, should be taken into consideration when applying tiered health plans broadly. Future work should investigate whether patients can and will switch to receive care from high-value physicians.


access high value care disparities 



This work was supported by funding from RAND and the University of Pittsburgh School of Medicine. We also are grateful for the critical advice provided by John Adams and for programming support from Supriya Munshaw.

Conflict of Interest

None disclosed.

Supplementary material

11606_2010_1607_MOESM1_ESM.doc (2.3 mb)
Online Appendix (DOC 2332 kb)


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Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Sean Tackett
    • 1
  • Chuck Stelzner
    • 2
  • Elizabeth McGlynn
    • 2
  • Ateev Mehrotra
    • 1
    • 2
  1. 1.University of Pittsburgh School of MedicinePittsburghUSA
  2. 2.RAND HealthPittsburghUSA

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