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.
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.)
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.
network comparison tool,
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.
In 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?
health insurance mergers,
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
Making 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?
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.
Relatively 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:
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/
network comparison tool,
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:
- 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?
mental health care,
behavioral health networks
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.
There’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?
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.
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?
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.
network comparison tool,
health care provider,
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.
Carriers 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?
The lines of communication between doctors and insurance companies are key elements to make sure that patients get the treatment they need. Kaiser Permanente established a medical school affiliated with its hospital system with a vision “to provide a unique medical education embedded in a physician-led health care delivery system, that ignites a passion for learning, a desire to serve, and an unwavering commitment to improve the health and well-being of patients and communities.” The school broke ground in September 2017 and will enroll its first class of students in the fall of 2019.
Carey Goldberg, CommonHealth blog editor at WBUR, interviewed Dr. Mark Schuster about his plans for the Kaiser Permanente School of Medicine. Here are some highlights:
- Students will have experience in clinical settings from the very beginning. Schuster says, “our students will be in clinical settings from the start, doing work that’s appropriate to their level of experience. They might be interviewing patients or serving as navigators for them. We want our students to understand what it's like to be a patient who is intimidated by the health care system, fearful of potential diagnoses, confused by the jargon.”
- Courses will use a variety of teaching and learning methods. Classes will be small-group and case study-based. Spiral learning techniques will be used – introducing concepts early and returning to them regularly as students progress. Some classes will be ‘flipped’; where students watch videos, complete exercises, and read ahead of class so that class time can be spent in more interactive pursuits.
- Graduates will contribute to a wide variety of communities. Schuster wants “students to be able to choose their field and where they practice without the constraints of the high debt that so many medical students have.” And Kaiser Permanente is providing the school with significant financial aid. Additionally, students will not be obligated to work for Kaiser Permanente after graduation. “The goal is to teach students who will spread out around the country and beyond, and take their skills everywhere and teach others around them,” said Dr. Schuster.
The Kaiser Permanente system is unique in that it is an integrated delivery system that also offers insurance. Their goal of preparing doctors who are lifelong learners, focused on health instead of disease, go beyond the clinical setting to understand patients’ needs, and use data to find gaps and solve problems who can share that knowledge throughout the healthcare system is admirable. The first class of prospective doctors will have 48 students and subsequent classes will grow to 96 students.
Is this a strategy that other public and private health insurers would benefit from? Are there opportunities for collaboration in areas like evidence-based medicine and establishing coverage in health professional shortage areas?
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.
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.
It’s important to know which specialties are included in a provider network in order to be able to make an accurate, fair comparison.
network comparison tool,