Public Health Researcher Targets Alarming Aspect of Medicare Advantage Plans

A University of Maryland researcher is about to go ghost hunting, with support from a $100,000 grant from the Robert Johnson Wood Foundation (RWJF). It’s not your regular ghostbusting—Assistant Professor Mika Hamer of the School of Public Health’s Department of Health Policy and Management aims to uncover the extent of so-called “ghost networks” in Medicare Advantage health insurance plans.

“Ghost networks” is a term for health care providers advertised as “in network” for insurers, but who are not available to deliver care—often resulting in more options on paper than in reality. Medicare Advantage, which provides health insurance for upward of 33 million Americans over 64 years old, or over half of Medicare clients, according to KFF, an independent health policy research organization, already has a limited network of providers compared to Medicare.

“By learning how big these ghost networks are, why they exist and who they affect most, we will then be able to offer practical policy solutions to help,” said Hamer, an assistant professor in the SPH Department of Health Policy and Management. “We already know that accessing health care and finding doctors who are accepting new patients is a problem. This study will pinpoint exactly where and how many ghost networks exist in Medicare Advantage, and who is most affected by larger ghost networks.”

Hamer’s research will focus on patients’ health care access, quality and equity related to Medicare Advantage plans, and will examine nationwide Medicare Advantage enrollment and visit data and provider network data from 2017 to 2021. Beyond identifying the ghost networks, the study will also examine geographic locations, race, sex, ethnicity, age and other factors of people participating in plans with ghost networks.

“We are thrilled to be working with Dr. Hamer and UMD School of Public Health to make valuable data available to this important research around ghost networks in Medicare Advantage. This study is poised to contribute actionable evidence to advance quality and access to care for Medicare Advantage enrollees,” said Megan Collado, senior director at AcademyHealth, the organization that manages the RWJF Health Data for Action program.