In a previous post, we talked about the four types of network analysis the employee benefits industry developed to measure and compare provider networks. Each type of analysis is valuable at different points in the selling process:
- Early stages to convince groups and brokers to consider a network
- Network counting: measure the quantity of providers in each network
- Accessibility analysis: correlate network provider locations to employee home and work location
- Later stages to demonstrate savings and convenience for members
- Disruption reporting: match historical provider utilization and claims experience for a group to the providers in a different network
- Repricing: compare cost of claims for all providers (in- and out-of-network) if a different network were in place to the cost experienced in the current network
- Counts. Access points, unique providers, or unique locations? Choosing the right counting method can make all the difference in how your network is perceived. If you have fewer access points and fewer locations/provider you might find that a unique provider count presents a better picture of your network than access points.
- Locations/provider. Use the NetMinder Snapshot to find this metric or compare access points to unique locations to see how your network looks versus your competitors’ networks. A high locations/provider ratio can indicate directory inflation.
- Total change. The sum of adds and drops in a network during a specified time period. Use this metric to showcase a geographic area – deliberately adding and removing providers to improve the network.
- Net change. The difference between adds and drops in a network during a specific time period. Use this metric to show growth or contraction over time.
(Total change and net change are both available in the NetMinder Network Change report.)
In general, the process of comparing provider networks is the same whether you are comparing dental, vision, or medical HMO networks. However, each line of business has a few specific metrics to address unique situations. Here are a few that we use regularly:
- PCPs/total providers. The percentage of a medical network that is primary care providers (usually internal medicine, general practice, family practice, OB/GYN, and pediatrics) is particularly important when evaluating a medical network. A lower percentage can result in longer wait times for members to get appointments. It also could indicate that different types of providers are identified as PCPs which could also cause disruption to members when changing plans.
- ECPs/total providers. The percentage of a vision network that is eye care providers (optometrists and ophthalmologists) is a significant distinction. Consumers gravitate to ECPs for exams and retail chains for glasses and contact lenses so having a selection of both types of providers can increase member satisfaction.
- Practicing providers and locations/all locations. The percentage of a dental PPO network that is practicing can make all the difference because directory inflation is common. NetMinder validates locations using claims data which helps focus recruiting efforts and clarify the network landscape.
When you tell your network story, which metrics do you use to support it?