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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: provider directories, medicare advantage, 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 comparisons, network comparison tool, health care provider, ZIP census

 

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