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The NetMinder Blog

What Gets Measured Gets Managed - Adds and Drops

Posted by Susan Donegan on Thu, Apr 05, 2018

“Adds” are providers that are new to your network – or your competitor’s. Adding new providers to your network means more choice for current clients and less disruption for potential new clients and enrollees. Measuring the number of new providers added to your network, segmenting the new participants by specialty, and sharing reports with clients and prospects regularly can be useful sales tactics.

Adds_Drops

But comparing your adds to those of competitors can be even more valuable. If you’ve added more in total, or more in a particular specialty, the sales team can use this information to demonstrate growing competitive strength. And what if the competitor has added new providers you don’t have? There’s no better way to identify targets for recruitment. 

“Drops” are providers who have left the network. Turnover is an important metric, and is often included as a performance guarantee in RFPs for new business. “After adjustment for plan characteristics, health plans with higher primary care provider turnover rates had significantly lower measures of member satisfaction,” according to a study published in the American Journal of Managed Care.

It is important – and relatively easy – to measure your own turnover rate. This is an indicator executives often use in setting performance targets for provider relations teams. You should be able to drill down geographically, and by specialty. But what if a sales professional could say to a prospective client: “Our turnover rate for primary care physicians is the lowest in the state – 12.5% better than the closest competitor. If you’ve dealt with employees lately who’ve experienced disruption, you know how important that can be!” Specific, accurate comparisons are much more compelling than phrases like “low turnover.” 

Download our whitepaper to better understand the dynamics of provider networks and measuring all of the productivity index components - adds, drops, net change and total change.

Tags: network metrics, network comparison tool, network comparisons, healthcare providers, network disruption, network strength, network analysis

Expanding Your Vision Network With Online Retailers

Posted by Laura McMullen on Wed, Mar 28, 2018

glasses.jpgAs of October 2017, there were roughly 52,000 vision care locations that participate in at least one PPO network, in the NetMinder database. According to the Vision Council of America, 3 out of 4 Americans need glasses or contact lenses. If the population and the vision care locations were evenly spread out across the country, each location would serve about 4,800 people. Of course, they aren’t which makes the rise of online eyeglass and contact lens purveyors inevitable.

Buying glasses and contact lenses online has become simpler.

Wherever you decide to purchase your glasses and/or contact lenses, you need a prescription and an eye exam from an optometrist or ophthalmologist to get started. To buy online, you upload your prescription and other pertinent information and then move on to shopping.

When you shop online for glasses, like anything else, you can get a lot of information without going anywhere or talking to anyone. There are many more style, color, and other option choices than you’ll find in a brick-and-mortar store. And you can save money: Consumer Reports estimated savings of up to 40%. On the flip side, you could get the wrong prescription or glasses that don’t fit correctly since you might need to measure your own pupil distance. It might also be hard to return the glasses. And you might not be able to use your insurance. WebMD summarized the pros and cons of shopping for glasses online here.

Shopping for contact lenses has similar pros and cons although since disposable contact lenses have been widely available for a long time, mail order retailers, such as 1-800-contacts, have been part of the marketplace longer. Demand for lenses that change eye color and other fashionable products has grown the market further. There are more factors to consider when purchasing contact lenses in general that require the assistance of an optometrist or ophthalmologist. WebMD summarizes them here.

Can you use vision insurance when you shop for glasses or contact lenses online?

Sometimes. You can always use the funds in your FSA or HSA. Some accounts have debit cards to pay directly while other plans require reimbursement. Some online vision retailers are in-network with vision PPOs and will accept benefits while others are out-of-network and will provide a detailed receipt to support reimbursement.

We looked at some online retailers to learn about their policies. Here’s what we found:

  • A few retailers are In-network with some carriers. Members can access benefits online.
Warby Parker – glasses only
Glasses.com - glasses only
Contactsdirect - contact lenses only
  • Most online sources for glasses and contact lenses are out-of-network with all carriers.

Glasses

Felix + Iris
Eyebuydirect
Coastal - glasses and contact lenses
Classicspecs

Contact Lenses

1800contacts
Walgreens
Walmartcontacts.com

Vision insurance doesn’t get as much airtime as medical and dental insurance in general. However, a significant percentage of people with insurance have coverage. In fact, the Centers for Disease Control estimate 58% of people with private insurance have optional vision coverage and 44% of people with public insurance have optional vision coverage.

Online retailers have made inroads into the market. How do they fit with your vision network? How do you compete with other networks that include online retailers if yours doesn’t?

Tags: vision market, optical retail, Vision insurance, vision networks, contact lenses, eyeglasses

Gauging the Productivity of Your Network Development Activities

Posted by Susan Donegan on Wed, Mar 07, 2018

When you subtract the number of providers who leave the network from the number who've joined for a time period, you get an important metric, Net Change. Net Change measures the overall growth in a network. Potential clients are looking for long-term relationships, and while losing providers isn’t positive, the ability to replace them efficiently is a strength.  

net change.jpg

In the example above, while Network A lost 8% of its providers during the time period versus only 6% for Network B, it was able to more than replace them, with adds of 14%. Network A’s net growth of 6%, compared to the competitor’s growth of just 2%, can be positioned as a clear advantage. From a management perspective, Net Change also serves well as a key performance indicator for provider relations teams.

Another important metric is Total Change, which demonstrates the amount of movement in a network or a market. While Net Change measures network growth, Total Change simply measures movement. It shows the overall change in the makeup of the network over time. Using the previous example, Network A had a total change of 22% (14% adds plus 8% drops) versus Network B’s total change of 14% (8% adds plus 6% drops.)

total change.jpg

Employed by itself, Total Change is not all that revealing. However, when combined with Net Change, it creates a powerful new metric for gauging the productivity of your network development activities compared to internal benchmarks and relative to your competition, which we call the Network Productivity Index.   

Download our whitepaper to better understand the dynamics of provider networks and measuring all of the productivity index components - adds, drops, net change and total change.

Tags: network growth, compare networks, health insurance, network comparison tool, network productivity, healthcare providers

Healthcare Mergers On the Rise in 2018

Posted by Laura McMullen on Thu, Feb 22, 2018

A trend that got a lot of attention at the end of 2017 was insurers moving further into healthcare delivery. These three high-profile transactions are just the latest examples:

  • Humana purchased 40% of Kindred Healthcare, a group of long-term acute care and inpatient rehabilitation hospitals.
  • United Health Group purchased DaVita Medical Group, nearly 300 clinics and six outpatient clinics in Florida, California, Colorado, Nevada, New Mexico, and Washington, from DaVita Inc., one of the largest kidney care companies in the U.S.
  • CVS is buying Aetna, combining CVS’ retail presence, pharmacy solutions, infusion services, and nursing professionals providing in-clinic and home-based care across the nation with Aetna’s national, regional, and state insurance offerings.

mergers and acquisitions.jpgIn Pennsylvania, the line between providers and insurers has been blurred for a long time. Highmark Health and the University of Pittsburgh Medical Center are realigning their networks as they compete for market share in central Pennsylvania. Most UPMC hospitals are leaving the Highmark network in June 2019. Highmark’s Allegheny Health Network announced a partnership with Penn State Health in December 2017 and a joint venture with Geisinger in May 2017. UPMC formed a joint venture with Reading Health System in late 2016 to offer health insurance in southeastern Pennsylvania and completed a merger with PinnacleHealth in September 2017. Additionally, both systems are investing in specific service lines in Pittsburgh. This Modern Healthcare article details the rivalry between the two companies.

And more mergers appear to be on the way in 2018. The results of a Capital One Healthcare survey in Modern Healthcare found that about half of the respondents in its middle-market sample plan to buy or merge with existing businesses this year. In addition, 20% said they plan to revitalize and update existing offerings while 21% said they plan to launch new segments or sectors. The primary reasons cited for these actions are pricing pressure, availability of private equity, and filling in service gaps. The uncertainty around the Affordable Care Act is inhibiting the desire to add new businesses somewhat, particularly in segments dominated by government-sponsored insurance.  

How are provider mergers affecting your network? What about provider-insurer combinations?

Tags: health insurance mergers, healthcare system, healthcare providers, insurance networks, healthcare networks, healthcare mergers, healthcare insurers

Do We Count Access Points or Unique Providers?

Posted by Laura McMullen on Thu, Feb 08, 2018

This question has been around since the first time someone decided to compare two provider networks. In fact, NetMinder wouldn’t be here without it! One of our founding principles is a commitment to comparing apples to apples. This thread runs through all our processes starting with the way we collect data and ending with selecting report criteria. We’re focused on this idea because we know that how you count network providers can make a big difference in calculating network strength. Read our whitepaper about counting providers.

Choosing The Best Counting Method For Your Analysis

Each counting method has strengths and weaknesses. Access points is the broadest count with the highest numbers. It’s great for showing consumers where they’ll be able to access care. Unique providers (sometimes called “belly buttons”) is often the cleanest count and preferred by benefits decision-makers. It’s not so good for consumers since it doesn’t show all locations. Unique locations (sometimes called “doorbells”) is the narrowest count with the smallest numbers for obvious reasons.

One Report To Show Them All

Dental_Dashboard.jpegMaking sense of these options is why we added a new Dental Dashboard to our suite of snapshot reports. It shows all three counting methods plus validated counts and percentages for a single geographic area in the same report. The six bar charts bring access points, unique providers, and unique locations together for up to five networks. Watch this video to learn more.

Each counting method is important at different points in the sales and renewal process and the Dental Dashboard makes it easier to look at them all. For example, access points are important to consumers when they are making appointments while HR teams rely on unique providers to compare networks. This report helps you prepare for questions about both scenarios and encourages a broader view of the reliability, convenience, and strength of your network.

How are you counting and comparing the providers in your network?

Tags: compare networks, network providers, counting method, network strength, access points, unique providers, provider network, unique locations

Synergies Helping the Dental and Vision Insurance Markets Work Together

Posted by Susan Donegan on Fri, Jan 26, 2018

In dental and vision insurance, the network is where the consumer experience happens. That’s why it’s important to know the network landscape and leverage all points of differentiation and separation from the competition.

First, a few definitions. These observations are based on a review of NetMinder data for the top 15 national dental PPO networks and the top 10 vision networks as of March 2015. A network is defined as a payer/plan combination, i.e. Delta Dental PPO or EyeMed Access. Counting methods are:  

  • Access Points: each provider at each location in a provider directory.  
  • Unique Providers: each provider one time regardless of the number of locations s/he is listed at in a provider directory.
  • Locations: each location one time regardless of the number of providers who are listed there in a provider directory.

AvgNetworkSize.jpgRelatively speaking, dental networks are much larger than vision networks. The supply of dentists is larger than the supply of optometrists and ophthalmologists. There are 65 dental schools vs. 23 optometry schools23 and nine dental specialties vs. two optometric specialties.

There is also greater demand for dental services:

demand_dental_vision.jpg

Download our whitepaper to learn more about these favorable trends as well as the synergies that help the dental and vision insurance markets work together. 


23 https://en.wikipedia.org/wiki/List_of_dental_schools_in_the_United_States:
24https://www.quora.com/How-long-does-a-routine-dental-checkup-normally-take-in-the-U-S-if-the-patient-is-perfectlyhealthy-and-schedules-one-every-six-months
25http://www.webmd.com/eye-health/what-to-expect-checkup-eye-exam-adults#1
26 http://health.costhelper.com/teeth-cleaning.html
27 http://eyeexamcosts.com/understanding-eye-doctor-costs/

Tags: NetMinder, dental network, network comparison tool, dental insurance, Vision insurance, vision networks, practicing locations, network analysis, access points, unique providers, provider locations

How Does the Narrow Network Trend Play Out in Behavioral Health Networks?

Posted by Laura McMullen on Thu, Jan 11, 2018

A recent article from Kaiser Health News discussed a study from researchers at the University of Pennsylvania about narrow behavioral health networks. The researchers compared mental health provider participation in marketplace networks to primary care physician participation in the same networks using 2016 data from the Robert Wood Johnson Foundation for 531 provider networks offered by 281 insurance carriers in the marketplaces in every state plus the District of Columbia. 

Here’s what they found:mental healthcare.jpg

  • The average provider network includes 11% of all the mental health care providers in a given market while 24% of PCPs participate.
  • An average marketplace plan’s network includes just under 25% of all psychiatrists and 10% of all non-physician mental health care providers. Non-physician mental health care providers included psychologists, nurse practitioners and physician assistants, and behavioral specialists, counselors and therapists with master’s or doctoral degrees.

How do these counts compare to commercial behavioral networks? We looked at unique provider counts in the 5 largest behavioral health networks in NetMinder and here’s what we learned:

  • Total mental health care provider participation ranges from 18% - 27%. Total PCP participation ranges from 27% - 41% in medical networks from the same companies.
  • Commercial networks include 12% - 34% of psychiatrists and 16% - 42% of psychologists who participate in at least one network.

While more behavioral health providers participate in commercial networks, the trend is similar. The study went on to consider reasons for the gap:

  • Low levels of network participation among mental health care providers. Among physician specialties, psychiatrists are least likely to join networks, according to a 2014 study in JAMA Psychiatry. While this research was limited to psychiatrists, other private-practice mental health providers have similar participation levels.
  • Reimbursements drive behavior. Many plans don’t reimburse providers for case management and other non-physician services. Psychiatrists prescribe medication which is reimbursed at a higher rate than therapy and often covered in medical plans leading them to participate in those networks instead of behavioral health networks.
  • Shortage of mental health providers. While psychology is consistently one of the top 10 college majors, there is a shortage of psychiatrists and psychologists, as we noted in a 2016 post. In 2017, psychiatrists are ranked #17 and psychologists are ranked #30 in US News and World Reports list of 100 Best Jobs based on demand, salary, job satisfaction, and other factors.

The decade-long push for mental health parity in insurance coverage has provided incentives to fill this gap. Primary care physicians, physician assistants, and other non-physicians are providing mental health services. In fact, NPR and Kaiser Health News reported that a recent Milliman study found that “insurers paid primary care providers 20 percent more for the same types of care than they paid addiction and mental health care specialists, including psychiatrists.”

How is your network adapting to the changing market?

Tags: narrow networks, healthcare benefits, healthcare providers, behavioral health, mental health care, behavioral health networks

Four Ways to Improve Your Provider Directory’s Accuracy

Posted by Laura McMullen on Fri, Dec 15, 2017

Initiatives to Improve accuracy in provider directories are gathering steam in companies that offer Medicare Advantage plans. Because the federal government pays for these plans, it’s no surprise that regulations and the vendor approval process are driving the improvements. CMS audits online directories and if inaccurate data is found, it can affect the plan’s star ratings. Regulations allow for civil monetary penalties, notices of noncompliance, and warning letters for deficiencies – which affects Past Performance Analysis results that could lead to denied applications.

provider data.jpgThere’s also a promotional impact. Star ratings are used by beneficiaries to choose between Medicare Advantage plans, so a drop there could discourage enrollment in favor of a plan with a higher rating. And the enrollee “grapevine” is sure to spread the word about how difficult it is to make appointments because the provider directory is inaccurate which can also affect enrollments.

Perhaps more important than the downside of inaccurate data is the upside of better business results. “Plans need accurate, complete provider data to run their business, especially with value-based care arrangements and things like that,” Lucia Giudice, Deloitte Consulting’s managing director and government programs practice leader told AIS Health for an October article in Medicare Advantage News (registration required). For ACOs and other organizations better data translates directly into better revenues.

AIS Health/Medicare Advantage News interviewed Kenneth Wrzos, senior director for operational excellence at EmblemHealth, about their provider directory information. Here are some tactics they find useful that can be applied to any provider directory for any line of business or type of plan:

  • Use a “front-end validation team” to assess the quality of provider data from delegated entities before adding it to the network. This team calls a sample of providers and then a network management team works with the providers to correct any inaccurate data.
  • Audit internal directory data periodically. This proved so helpful EmblemHealth increased the frequency from quarterly to monthly.
  • Analyze claims data to target records for cleaning. Locations that haven’t been paid at least one claim in 12 months get special attention. This has proven helpful in reducing dental directory inflation.
  • Reconcile rosters with large groups regularly. Staff at large group practices change frequently which can have a big impact on your network. Getting ahead of these changes by periodically comparing the provider’s office roster to your provider directory makes things easier for everyone.

Clean provider information in your directory is a competitive advantage. What are you doing to make it easier for current and prospective members to find what they are looking for?

Tags: medicare advantage, provider directories, healthcare providers, healthcare networks

NetMinder Shows the Maximum and Compares Your Network to the Competition

Posted by Susan Donegan on Fri, Dec 01, 2017

In order to present a more complete picture of network strength relative to a population, we propose including another metric – choice of providers – to the analysis. When you add the average number of providers employees can choose from to the percentage of employees with access to a minimum number of providers, you can better assess the relative strength and attractiveness of one network versus another.  NetMinder shows the maximum.jpg

Using an employee census to run a network summary report gives you the opportunity to focus your analysis on areas important to the client - do large concentrations of employees have adequate choice?Network Summary Report sample.jpg

The resulting report output shows that while My Network doesn’t have the most providers within 5 miles of the employees, (327 versus 337 for Competitor C), it does have the most choice (14 providers on average vs. 11 for Competitor B) in my census locations and it meets the accessibility criteria - 100% of employees having access to at least 5 providers. Therefore I can say to the prospect or the broker that My Network is the strongest option for this group of employees – all employees have the required network coverage and the most choices of providers. 

Watch and learn how to get the most out of NetMinder using your client's employee census.

Tags: compare networks, network comparison tool, network comparisons, health care provider, ZIP census

The Fine Line Between Differentiation and Disruption

Posted by Laura McMullen on Thu, Nov 16, 2017

Switching networks can be rough, as the Texas Employees Retirement System found out when they switched to a Blue Cross Blue Shield of Texas HMO plan after using United Healthcare for several years. The Texas Blues plan uses the HealthSelect network which was designed for large groups offering ample coverage in Dallas, Houston, and other big cities. In rural areas, the Blue Advantage network, designed for small groups and individual plans, would have been a better fit, according to local experts. Blue Cross Blue Shield of Texas has moved quickly to address the network gaps. Members who are more than 30 miles from an in-network PCP or more than 75 miles from an in-network specialist can request network gap exceptions. Click here to read the Health Business Daily story that has more details from November 6, 2017. (registration required)

This type of situation happens all the time in the employee benefits industry. A network looks like it matches a group’s locations but when members start making appointments there are gaps. Minimizing network disruption to avoid employee dissatisfaction is often a big factor in making changes to the overall benefits package. Estimating disruption is one of the most common uses of NetMinder.

disruption.jpgCarriers have taken different approaches to managing the inevitable disruption that comes with changing benefit plans and networks.

  • Dental benefits companies frequently “stack” multiple lease partners on top of their direct contract network. Since many lease partners are working with multiple carriers, these networks are very similar which reduces disruption.
  • Vision benefits companies are starting to work with multiple lease partners which reduces disruption when moving between networks as well. Additionally, vision networks rely heavily on retail chains such as Target, Wal-Mart, and JCPenney which also reduces disruption.

Broad medical networks are alike due to the nature of employer-sponsored medical insurance: very few people decline it when offered and virtually all doctors accept insurance because costs are high and utilization is virtually guaranteed over a lifetime. Narrow networks, however, have introduced a new element of disruption into the medical network marketplace. As they continue to evolve, it will be interesting to see what tools and strategies are developed to minimize disruption and dissatisfaction caused by changing plans and doctors while keeping costs down.

How are your networks different from your competition? How do you measure and track the differences?

Tags: disruption reporting, Vision insurance, healthcare benefits, employee benefits, dental benefits, network disruption, medical networks

 

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