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The NetMinder Blog

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

Kaiser Permanente Hires Harvard Professor to Lead Medical School

Posted by Laura McMullen on Thu, Nov 02, 2017

medical school students.jpgThe 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?

Tags: health insurance, health insurers, healthcare system, healthcare providers, medical school, hospital system

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

 

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