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The NetMinder Blog

If You Think All Provider Networks Are Basically The Same, Think Again

Posted by Susan Donegan on Thu, Oct 19, 2017

After years of insurance companies and PPOs building and maintaining provider networks, the prevailing wisdom is that “all provider networks are basically the same.” A closer look at the composition of provider networks reveals something very different, however.

A comparison of two well-known, established provider networks in Florida shows that, while they both have almost the same number of access points (provider locations), the overlap between the two networks is only 47%. More than half of the access points in each network are unique to that network.comparison similarly sized networks.jpg

In order to better understand the differences between these two networks, we need to drill down to the specialty level. As you can see in the chart below, both networks have basically the same composition of Primary Care, Medical Specialists, and Surgeons. However, they vary significantly in other specialties such as Dental and Vision, Nursing, Therapists, and Behavioral Health.

specialties.jpg

It’s important to know which specialties are included in a provider network in order to be able to make an accurate, fair comparison.

Download our whitepaper, All Provider Networks Are Not Created Equal to learn how to use network data to demonstrate your competitive advantages for a specific client's needs.

Tags: network comparison tool, provider networks, network comparisons, provider directories, access points, provider network, provider locations

Superior Vision and Davis Vision to Merge

Posted by Laura McMullen on Thu, Oct 05, 2017

Centerbridge Partners, Superior Vision’s parent company, and HVHC, a wholly owned subsidiary of Highmark and the parent company of Davis Vision, announced two transactions in August:

  • vision.jpgCenterbridge will purchase Davis Vision, HVHC’s managed vision care subsidiary. Davis Vision will be combined with Centerbridge’s existing managed vision care portfolio company, Superior Vision. Highmark will acquire a minority ownership interest in the combined Davis Vision-Superior Vision company.
  • Centerbridge will acquire a minority equity stake in Visionworks, HVHC’s optical retail subsidiary. Highmark will retain a controlling ownership interest in Visionworks.

In 2013, Superior Vision merged with Block Vision, covering more than 8.5 million members nationwide, with a provider network surpassing 55,000 access points. Vision Monday reports that Superior Vision currently has more than 11 million members. Davis Vision reports more than 22 million members and more than 68,000 points of access including optometrists, ophthalmologists, and retailers in private practice and retail settings. 

With so many mergers taking place in the healthcare industry overall. We decided to also look at the evolution of selling dental and vision insurance as a key part of the total benefits package employers use to attract and retain top talent. Download our whitepaper, Exploring How Dental and Vision Work Together to learn more about the favorable trends as well as the synergies that help the dental and vision insurance markets work together. 

How does this new vision combination change the landscape in your territory?

Tags: optical retail, Vision, Vision insurance, vision networks

4 Ways to Measure Network Strength

Posted by Susan Donegan on Thu, Sep 14, 2017

The health insurance industry has developed a spectrum of network analysis tools to demonstrate a network’s breadth and depth, and to differentiate between networks.There are 4 common methods of network analysis widely used to evaluate health-related insurance products today. We visualize this spectrum as a pyramid to show how frequently the analysis is used and how specific the information is to each company. As you ascend the pyramid the frequency of availability decreases but the knowledge gained becomes more specific and as a result is more valuable to the overall assessment of the networks under consideration.4 ways to measure network strength.jpg

For example, at the bottom of the pyramid, measuring network size is fairly easy and is used in almost every analysis; it’s not very specific to a particular client or prospect. At the top of the pyramid, re-pricing the claims of the incumbent carrier is more difficult to do because it requires more data and cooperation from the prospect and the incumbent, therefore it’s done less frequently. However, when done, it’s very specific to the prospect’s situation. 

Download our whitepaper, The Network Analysis Pyramid for an overview of the most widely used methods to analyze provider networks.

Tags: compare networks, health insurance, network comparison tool, data analysis, network data, provider networks, repricing analysis

The Provider Directory is a Valuable Marketing Tool

Posted by Susan Donegan on Fri, Aug 25, 2017

A dental provider directory can be a valuable marketing tool for a dental plan. A large provider directory means more access to care for the members of the plan. And the conventional wisdom is the larger the directory the better.

dental-networks-over-stated.pngA provider directory grows in two ways:

  • by adding providers (dentists), and
  • by adding provider locations (places the dentist practices at).

The combination of providers (dentists) and all the locations they practice at is commonly referred to as access points, or provider/location combinations where a member can “access” care.  

The Industry Is Concerned That Access Is Overstated

One of the concerns in the industry regarding the access points counting method is that providers are being listed at more locations than they actually do or can practice at. This phenomenon is due to a few factors. First, just the like rest of us, dentists retire, sell their practices, or die. Second, associate dentists (employees) tend to move from practice to practice. In both of these situations, it is difficult for dental plans to stay on top of this information, and there may be a significant lag when updating provider directories.

Finally, and most importantly, large dental groups with multiple offices ofen require that dental carriers list all of their dentists at all of their locations, even though they may only regularly practice at 2 or 3 locations. This is so that they can easily move dentists around without disrupting claims payment from the carriers. There are more than 1,300 dental groups nationwide with 5 or more locations, with the average group having 13.7 locations, resulting in overstated access in provider directories. (NetMinder, March 2011) 

Download our whitepaper,  Are Dental Provider Directories Overstated?  to learn more about using "practicing" locations to get a better picture of network access.

Tags: dentists, practicing locations, dental plans, provider directories, network access, access points

Minimize Disruption by Maximizing Overlap

Posted by Susan Donegan on Thu, Aug 10, 2017

In order to minimize disruption for potential new clients, a dental plan needs to maximize its overlap with competitors' networks. In other words, they need to have as many of the same dentists as possible. What might be a manageable task when aiming to match up with a single competitor, this gets quite challenging for a plan with 8-10 significant competitors.network overlap.jpg

In the chart above, the blue circle represents Network A, a middle-of-the-pack network among the Top 15 dental PPO plans, while the gold circle represents the average of all of the Top 15 dental PPO plans. Network A, though quite large, only overlaps with its peers at a rate of 57%. This means that while 6 out of 10 access points in Network A's network are likely also to be in any given competitor's network, 4 out of 10 are not, and will potentially cause disruption for a prospective client. The challenge for Network A, as it is for all dental plans looking to grow, is to maximize their overlap with key competitors so that potential clients will experience minimal disruption when switching to their plan.  

Download our whitepaper, Recruit Smarter, Not Harder to learn how NetMinder data can help you target and recruit dentists more successfully and efficiently. 

Tags: market comparison, health insurance, disruption reporting, network overlap, network disruption

Studying the Accuracy of Provider Directories

Posted by Laura McMullen on Thu, Jul 27, 2017

Many people have had this experience – you’re looking for a new healthcare provider in your insurance plan’s directory and when you call, that doctor (or dentist or optometrist) doesn’t work at that location any more or the office isn’t accepting new patients. So you move on to the next name on the list and keep calling. As market forces, government regulations, and rising costs combine to focus more attention on every aspect of the health insurance industry, two recent initiatives examine provider directory accuracy.

provider-directory-4.jpg

CMS Online Provider Directory Review

In a previous post, we shared the preliminary findings from a CMS project designed to assess provider directory accuracy. CMS released the final report which confirmed that 47% of the 5,832 provider records reviewed in Medicare Advantage networks had at least one deficiency and listed the names and results of the 54 health plans involved in the audit along with the compliance actions taken. Fierce Healthcare summarized the results here.

AHIP Provider Directory Initiative

Between April and September 2016, AHIP executed a large-scale project to evaluate a variety of ways to update directory information. This issue brief summarizes the project including background on the vendors, methodology, and results of an independent evaluation by NORC at the University of Chicago. A blog post from March 2017, What It Takes to Improve Provider Directories, discussed the findings and offered potential solutions in actions that could be taken by providers and networks:

  • Provider side: enforce contractual requirements and offer incentives to providers
  • Network side: use multiple channels and media to connect with providers such as email, phone, mail, fax, and provider one source to update data for multiple plans

The prevalence of inaccurate data that CMS found and the low response rates plus lack of information about the importance of updating directory information underscore the complexity of maintaining this information. “The root cause of the problem isn’t the directories themselves; it’s the underlying data. Capturing, storing, and retrieving provider data has always been a complex process,” writes Mark Martin, Availity’s director of payer solutions, provider data management, and Dianne Wagner, senior director, provider engagement and enablement at Guidewell, in Managed Healthcare Executive.

The importance of accurate provider directories to the whole healthcare industry – consumers find providers and make appointments easily, providers earn the advertising and publicity benefits of inclusion in provider directories, and networks improve customer satisfaction, compare provider directories, and avoid compliance actions – make fixing this problem a chronic priority.

What steps are you taking to improve the accuracy of your provider directory?

Tags: health insurance, provider networks, provider directories, healthcare system, healthcare providers

Six Synergies That Make Selling Dental and Vision Plans Together Smart

Posted by Susan Donegan on Wed, Jul 19, 2017

Beyond their similar relationship to medical plans, dental and vision plans have several other synergies.

The same components are evaluated during the dental and vision benefits sales processes: benefit, price, and network. Both products have defined benefit structures that can be compared on specific points. Rates are presented in tiers based on job classifications and number of people covered. Networks are less complex than medical plans and specific tools and processes have evolved to compare apples to apples.

The same network analysis tools can be used for both products to differentiate between networks. The sales process requires size comparisons, accessibility measurements, overlap/disruption analysis, and sometimes re-pricing analysis. network analysis pyramid.jpg

Beyond the departments that all companies have such as IT and facilities management, dental and vision plans can share functions like pricing, sales, marketing, and underwriting. Many multiline carriers have shared sales forces that use a single point-of-contact as a selling advantage. There are also departments that perform similar functions like recruiting and credentialing, where process synergies can come into play.

And, distribution strategies, like whether or not to be on an exchange, broker marketing strategies, and voluntary/worksite programs, since both products are voluntary-friendly, can be leveraged across both lines of business.

Download our whitepaper,  Exploring How Dental and Vision Work Together to learn more about the synergies that help the dental and vision insurance markets work together. 

Tags: dental network, health insurance, healthcare benefits, vision networks

The Best Solutions to High Healthcare Costs Are Local

Posted by Laura McMullen on Tue, Jul 11, 2017

A new interactive mapping tool and issue brief released by the Health Care Cost Institute with support from the Robert Wood Johnson Foundation shows wide variation in prices for different categories of medical services within communities and across the country between 2012 and 2014.

map of US.png

The Healthy Marketplace Index: Medical Service Price Category Index uses annual health care claims data from over 40 million Americans under age 65 with employer-sponsored insurance which accounts for more than 25% of the commercially insured population in the US. Aetna, Humana, Kaiser Permanente, and UnitedHealthcare contribute data to this project. The information is organized by CBSA, Core Based Statistical Areas, which are commonly used geographic regions of economic integration comprised of counties.

Users can look at costs in three categories: inpatient, outpatient, and physician services. Costs rose in all three categories although not at the same rate. “Prices for outpatient services rose fastest, while physician price increases were minimal. The most consistent growth was seen in inpatient prices which increased, on average, five percent each year,” the report notes.

Other highlights are:

  • There’s a link between inpatient and outpatient price levels. The report hypothesizes that “some aspects of the drivers underlying inpatient and outpatient prices may be related, such as commonalities in labor supply or population health.” HCCI found only a minimal relationship between physician services and the other two categories.
  • Some markets are consistent in pricing across categories. For example, prices in Cincinnati are consistently below average, prices in Nashville are consistently average, and prices are consistently high in Dallas. Other markets, such as Trenton, New Jersey had average inpatient and physician prices, but high outpatient prices compared to the national averages.

Download the issue brief or try out the mapping tool to see what your key markets look like.

Tags: health insurance, claims data, healthcare cost, inpatient services, outpatient services

NetMinder's Data Brings Intelligence to Recruiting

Posted by Susan Donegan on Tue, Jun 27, 2017

NetMinder provides the data you need to recruit proactively. A shorter target list of the best prospects makes it easier to succeed, and less expensive to do so.

Here are just a few of the ways network managers can use real market intelligence to recruit proactively.

  • intelligent recruiting.jpgLearn which dentists participate in many networks. They'll be more receptive to adding new networks and can help you grow more efficiently.
  • Find locations with multiple dentists. This creates efficiency in increasing sheer numbers of dentists.
  • Find dentists who practice in more than one location. This makes it easier to increase listed locations, compared to recruiting one at a time.
  • Find dentists where you know they are practicing. Confirmed by submitted claims, practicing locations are your best place to find dentists to recruit.
  • Target dentists who are heavily utilized. Selecting those with more cliams activity helps you find the more popular dentists.
  • Look for dentists who accept discounts. Prospects who accept discounts from others should be more affordable.   

Download our whitepaper, Recruit Smarter, Not Harder to learn how NetMinder data can help you target and recruit dentists more successfully and efficiently.

Tags: dental network, Healthcare, insurance companies, practicing locations, claims data, insurance networks

Insurers and ACA Marketplaces Over Time

Posted by Laura McMullen on Thu, Jun 15, 2017

We’re approaching CMS’ June 21 deadline for Qualified Health Plan applications and rate table templates for plans to be sold on healthcare.gov or the state marketplaces. So, it seems like a good time to look back over the last four years and see how the mix of insurers participating in the exchanges changed between 2014 and 2017.

ACA.pngThe Kaiser Family Foundation’s Health Reform blog has a nice summary here that includes interactive maps. Data for this analysis was gathered from healthcare.gov, state exchange enrollment websites, and insurer rate filings to state regulators.

Year by year overview

  • 2014: on average 5 insurers participated in each state, ranging from 1 insurer in New Hampshire and West Virginia to 16 in New York.
  • 2015: on average 6 insurers participated in each state, ranging from 1 in West Virginia to 16 in New York.
  • 2016: on average 5.6 insurers participated in each state, ranging from 1 in Wyoming to 16 in Texas and Wisconsin. The mix of carriers in each state changed a lot in 2016 as CO-OPs failed and new plans entered the market.
  • 2017: on average 4.3 insurers participated in each state, ranging from 1 in Alabama, Alaska, Oklahoma, South Carolina and Wyoming to 15 in Wisconsin.

Other findings from the analysis

  • There are fewer choices in most counties. In 2017, 58% of enrollees (living in about 30% of counties) had a choice of three or more insurers, compared to 85% of enrollees (living in about 63% of counties) in 2016.
  • Rural areas have fewer insurers than metro areas. In 2017, metro areas have 2.5 insurers vs. 2 insurers in rural areas. 87% of 2017 enrollees live in metro areas.
  • Many counties are served by one carrier, most likely a Blue Cross Blue Shield or Anthem plan. In 2017, about 21% of enrollees (living in 33% of counties) have access to just one insurer on the marketplace (up from 2% of enrollees living in 7% of counties in 2016).

How has the mix of insurers impacted your network? Has your network participation in the ACA changed over the last four years?

Tags: health insurance, Affordable Care Act, ACA. healthcare exchanges, Healthcare, ACA, health insurance co-ops

 

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