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The NetMinder Blog

Aaron Groffman

Recent Posts

All Provider Networks Are Not Created Equal

Posted by Aaron Groffman on Mon, Dec 23, 2013

Overlap between provider networks has emerged as an important metric in determining network strength.  NetMinder data on the top 15 national dental PPO networks shows that similarly sized networks can actually be quite different in terms of overlap, or how many providers they have in common.

Recruit Smarter, Not Harder whitepaper

Why is network overlap important? Here are three key reasons:

  • The dental benefits market is relatively flat. From 2002 to 2011, the percentage of the U.S. population with dental benefits has ranged between 54% and 58%.
  • Take-away business fuels dental plan growth.
  • Minimizing disruption for plan members is important if you want to take away business, and a higher rate of overlap with your competitors’ networks means less disruption.

Among the top 15 national dental PPO networks, the overlap in access points ranges from 39% to 68%, while the overlap in unique dentists ranges from 53% to 88%. 

The greater the overlap you have with as many networks as possible, the better positioned you are to take away business from your competitors.

Download our new whitepaper to learn how to “Recruit Smarter, Not Harder.”

Tags: network growth, dental network, network providers, dental insurance, dental PPO networks

Which Provider Counting Method Do You Prefer?

Posted by Aaron Groffman on Mon, Dec 09, 2013

I asked attendees at my recent NADP CONVERGE 2013 break-out session which counting method they prefer to use for comparing provider networks, and the majority answered “unique providers.”

Counting Methods in NetMinder Dental PPO Reports

Based on NetMinder user data (as illustrated in the chart), access points (each provider at each of their locations) is still used about half the time, but the unique providers counting method is catching up.  In 2012, 36.7% of NetMinder dental PPO reports used unique providers as the counting method, and 53.7% used access points. This year we started to see a shift, with 40.9% of reports using unique providers and 50.7% using access points.

It makes sense that unique providers would be the preferred counting method for NADP attendees, who tend to be senior level managers looking for a big picture view of how their company is performing. Using unique providers simplifies the equation because it means each provider is counted once regardless of how many locations he or she is listed at. This eliminates duplication caused by a) associates who change offices and b) providers who are listed at multiple locations to facilitate claim payment.  Looking at access points with an overlay of our exclusive practicing locations indicator offers a similar view to counting unique providers with the added benefit of including multiple locations that have been validated by claim activity.

Which counting method do you prefer and why?

Tags: network growth, dental network, network providers, dental providers

NetMinder Data Reveals Dental PPO Network Trends

Posted by Aaron Groffman on Thu, Oct 03, 2013

 

Size is one of the key ways to measure network strength, and the latest NetMinder data reveals that dental network size continues to increase.

There are two ways that networks generally grow:

  • Organic growth through direct contracts with the dentists themselves
  • Partnerships, leases and reciprocal arrangements

We see a clear trend that indicates both are happening. More networks are partnering, and dentists are joining more and more networks.

Dental Network Trends NetMinder Aug2013 resized 600Out of the top 15 national dental PPOS, 13 have one or more partners, according to our data. More than half have three or more lease partners, and the partners are not limited to traditional rental networks. Even carriers are offering some or all of their contracted providers in partnership arrangements.

Additionally, dentists continue to join more networks. From March 2009 to March 2013, the average number of networks per dentist in the top 15 networks grew from 6.2 to 7.4. Now 37% of dentists are in 11-15 networks, compared to just 26% of dentists participating with that many networks in 2009. By contrast, the
number of dentists in one to five networks shrunk from 55% to 46%.

Part of this increase can be attributed to the multiplier effect. When a dentist joins a lease network, he or she ends up in many networks.

I’m going to be diving even deeper into the data in the coming weeks, so stay tuned for more dental PPO network trends!

Tags: network growth, dental providers, dental PPO networks, dentists

More Health Systems Becoming Payers

Posted by Aaron Groffman on Thu, Sep 05, 2013

More than 20 percent of hospitals and health systems in a recent survey said they are planning to launch a health insurance plan by 2018.

Another 34 percent of respondents said they already own health plans. The June 2013 survey was conducted by by the Advisory Board Co., a Washington, D.C.-based research and consulting firm, and included more than 100 U.S. hospitals and health systems.

Health insurance exchanges, the aging boomer population, increasing cost and reimbursement pressures and an industry-wide move toward population health are driving many health systems’ decisions to become payers, despite the risk of that move in the continually changing healthcare industry.

North Shore-LIJ Health System, a Long Island, NY-based hospital system, plans to offer its health plan called CareConnect on the state health insurance exchange beginning October 1st.

Providers that offer health insurance typically offer a narrow network composed of their own hospitals and affiliated physicians. But in order to be successful, a network must include enough facilities and physicians to provide access and member convenience. Therefore, some health systems are joining forces to create health plans with stronger networks than either could offer on its own.

For example, Piedmont Healthcare and WellStar Health System, two Atlanta-based systems, are partnering on a health plan called the Georgia Health Collaborative that will offer commercial and Medicare Advantage products starting in 2014.

If you were starting a health plan, how would your network compare to your competitors?

Tags: network growth, network providers, health insurance, Affordable Care Act, Healthcare, Healthcare, healthcare reform, health reform, healthcare benefits, Obamacare, health insurers

How Will ACA Affect Managed Vision Care Network Models?

Posted by Aaron Groffman on Tue, Aug 13, 2013

As healthcare reform continues to take shape and the market becomes even more consumer-centric, insurance companies need to make sure their networks are in line with what customers want. The Patient Protection and Affordable Care Act (ACA) will create new market opportunities  both inside and outside of exchanges  for vision providers and insurers.

For example, the public exchanges will require all medical plans to include pediatric vision coverage, potentially increasing the number of people who will get regular vision exams. On the other hand, ACA could mean that standalone vision plans will appear more often outside of the exchanges because public exchanges might exclude ancillary plans. Voluntary vision coverage tends to be a popular benefit with employees, however, so it’s unlikely that these plans will be going away anytime soon.

What types of plans do consumers prefer? Our research shows that managed vision care plans have to include a mix of independent eye care professionals (ECPs) and retail chains in order to win over consumers. So the next questions are: how are they currently achieving this balance and what are the most common network models?

The three primary types of network models in managed vision care are:

  • Flat organizations contract primarily with ECPs and a limited number of the smaller chains;
  • Vertically integrated organizations, whose networks include their own retail stores as well as ECPs and other retail chains;
  • Hybrid networks have more of an even distribution between ECPs and retail chains

To determine which approach makes the most sense for each managed vision care network, the planning process needs to account for the ACA’s impact (which seems to favor ECPs) and the growing corrective materials market (which seems to favor retail chains).

To learn more about managed vision network models, watch our free webinar: Clearing Up the Vision Market.

Tags: Affordable Care Act, vision market, Vision, Vision insurance, healthcare reform, Managed Care

New Whitepaper Clears Up Changing Vision Market

Posted by Aaron Groffman on Mon, Jul 01, 2013

Clearing up the Vision Market white paperVision insurers, medical insurers and insurance brokers will have a significant opportunity in the coming years as the growing market and changing make-up of vision care delivery impact vision care plans.

Vision care products and services are delivered at more than 47,000 U.S. optical locations, ranging from sole practitioners to mass merchandisers.  The market includes independent eye care professionals (ECPs) and retail chains. Market share indicators and loyalty metrics, such as the Net Promoter Score, show that consumers prefer ECPs for exams, but they more often choose retail chains for frames, lenses and contacts.

It’s clear from consumer purchasing preferences that managed vision care plans will need to include a combination of ECPs and retail chains in their provider networks to service the preventive and routine vision care needs of their clients.  The question is: what’s the right balance? 

To answer this question for your company, you first need accurate provider network data. Gathering and maintaining this information on your own can be expensive, time consuming, and subject to inaccuracy. The good news is we can help. Tracking more than 250 networks from national, regional and local vision, medical, dental, and behavioral plans across the country, NetMinder gives payers, brokers and consultants an objective, consistent, validated source of provider network data to use as they guide their customers in making smart employee benefit decisions.  

Download our new whitepaper, Clearing Up The Vision Market, to learn more about how the vision market is changing and what these changes mean for your company.

Tags: network providers, vision market, Vision insurance, consumer choice

Are Independent Eye Care Professionals Getting Their Share Of Market Growth?

Posted by Aaron Groffman on Tue, Jun 04, 2013

Vision care products and services sold at U.S. optical retail locations increased 5.8% from $28,624 million in 2011 to $30,287 million in 2012, as estimated by The Vision Council’s VisionWatch report. The nation’s top 50 optical retailers, representing 1 out of 5 retail locations, account for close to 27% of the total vision market, according to Vision Monday’s 2013 Top 50 U.S. Optical Retailers report and ranking.

VisionMonday 20130524Smaller retail chains, defined by VisionWatch as those optical retailers with 4 or more locations, accounted for 29% of the market while representing only 13% of total locations, according to the most recent NetMinder update.  Independent optometrists (eye care professionals, or ECPs, with 1-3 locations) account for 2 of every 3 retail optical outlets and control the largest share of the market.  In spite of their significant presence, ECPs’ market share is only 45%.  Why are ECPs’ revenues per location lagging the chains?  One reason may be that consumers gravitate to ECPs for the smaller, exam portion of the market, while preferring retail chains for the faster growing, more lucrative materials (frames, lenses, and contacts) segment.  

What does this mean for ECPs going forward?  Will they become marginalized by the big chains like so many other industries?  Or will their high-touch approach preserve their market position?

Tags: optical retail, sales, Vision, Vision insurance, consumer choice

2 Keys for Growing Provider Networks

Posted by Aaron Groffman on Fri, May 10, 2013

NetMinder data often reveals interesting patterns that we like to share for the benefit of our users and readers. For example, reviewing data about provider network participation revealed two important patterns that could make growing provider networks easier for insurers.

  1. Tips on Growing Provider Networks from NetMinderFind the newbies. Providers who recently started joining networks are more likely to join more. They’ve embraced the concept and may be ripe for your call.
  2. The more the merrier. Providers with a large number of network contracts are more likely to sign another. They understand the process and see the value of participation.

Finding providers with these attributes can pave the way for recruiting success. Have you noticed any other interesting and useful patterns when developing your networks?

Tags: network growth, dental network, network providers

Should Medicare Patients Buy Vision Insurance?

Posted by Aaron Groffman on Fri, Apr 26, 2013

Many Medicare patients don't have routine vision coverageNavigating Medicare can be tricky, especially when dealing with vision expenses. While most major procedures (e.g., cataract surgery, eye diseases) are covered, routine exams and eyeglasses are not, which leaves many older Americans with a coverage gap.

As a recent Wall Street Journal article states, there are some exceptions to the rule. For example, diabetes patients and those who are at high risk for glaucoma are entitled to an annual vision exam. Also, Medicare will pay for glasses and contact lenses for post-cataract surgery patients who have had a conventional “intraocular” lens inserted during the operation. And Medicare Advantage planholders, who have insurance plans that are run by private insurers, are typically covered for basic exams and prescription eyewear, but their vision provider network may be limited.

While those who don’t meet the criteria for routine vision coverage can save money by shopping for glasses or contacts through discount retailers, such as Wal-Mart or Costco, or through online retailers, such as Coastal.com, it seems the gaps in Medicare coverage may present an opportunity for vision insurers and brokers.  I would love to hear from readers – especially those in the vision industry. Do you think it makes sense for Medicare beneficiaries to seek voluntary supplemental vision insurance to cover gaps? 

Tags: Ancillary benefits, Vision insurance, medicare

3 Steps to Using Competitive Network Advantage to Win More Business

Posted by Aaron Groffman on Thu, Apr 11, 2013

Helpful Tips

I’m often asked how to use a competitive provider network advantage to win more business.  As I talk to NetMinder users, one of the best and easiest ways I hear is to leverage your network advantage to negotiate for better rates for prospects in your sales pipeline.  Try these three steps:

  1. For key prospects, assess your network compared to competitors.  Do you have more providers in areas with significant concentrations of your prospects’ employees?  Are you the market leader?
  2. Provide this data to your underwriting team.  Stress the expected higher in-network utilization and lower claim costs that will result.
  3. Demonstrate to your prospect how your network advantage will save them money.

As I wrote in Chapter 7 of Dental Benefits: A Guide to Managed Plans, the network is the product.  A competitive provider network strengthens your sales pitch! Try this approach and let me know if you see results.

Tags: network providers, dental insurance, insurance broker, Ancillary benefits, Vision insurance

 

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