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The NetMinder Blog

Insurers and ACA Marketplaces Over Time

Posted by Laura McMullen on Thu, Jun 15, 2017

We’re approaching CMS’ June 21 deadline for Qualified Health Plan applications and rate table templates for plans to be sold on or the state marketplaces. So, it seems like a good time to look back over the last four years and see how the mix of insurers participating in the exchanges changed between 2014 and 2017.

ACA.pngThe Kaiser Family Foundation’s Health Reform blog has a nice summary here that includes interactive maps. Data for this analysis was gathered from, state exchange enrollment websites, and insurer rate filings to state regulators.

Year by year overview

  • 2014: on average 5 insurers participated in each state, ranging from 1 insurer in New Hampshire and West Virginia to 16 in New York.
  • 2015: on average 6 insurers participated in each state, ranging from 1 in West Virginia to 16 in New York.
  • 2016: on average 5.6 insurers participated in each state, ranging from 1 in Wyoming to 16 in Texas and Wisconsin. The mix of carriers in each state changed a lot in 2016 as CO-OPs failed and new plans entered the market.
  • 2017: on average 4.3 insurers participated in each state, ranging from 1 in Alabama, Alaska, Oklahoma, South Carolina and Wyoming to 15 in Wisconsin.

Other findings from the analysis

  • There are fewer choices in most counties. In 2017, 58% of enrollees (living in about 30% of counties) had a choice of three or more insurers, compared to 85% of enrollees (living in about 63% of counties) in 2016.
  • Rural areas have fewer insurers than metro areas. In 2017, metro areas have 2.5 insurers vs. 2 insurers in rural areas. 87% of 2017 enrollees live in metro areas.
  • Many counties are served by one carrier, most likely a Blue Cross Blue Shield or Anthem plan. In 2017, about 21% of enrollees (living in 33% of counties) have access to just one insurer on the marketplace (up from 2% of enrollees living in 7% of counties in 2016).

How has the mix of insurers impacted your network? Has your network participation in the ACA changed over the last four years?

Tags: health insurance, Affordable Care Act, ACA. healthcare exchanges, Healthcare, ACA, health insurance co-ops

Which Counting Method Should You Choose?

Posted by Susan Donegan on Thu, Jun 08, 2017

apples to apples.jpgClients and brokers expect to see an “apples-to-apples” comparison of price and benefit design. NetMinder lets you do the same for networks. Choosing your counting method ensures that you always know what you are counting.

Comparing access points is important at the beginning of the evaluation process because it gives you the most granular view of each network. The networks look largest through this lens because each provider at each location counts as one access point. This view includes all locations that each provider could practice at, even if he or she doesn’t see patients there regularly. To avoid this problem, use the unique provider counting method.

The count of unique providers is the clearest count of contracts that each network has. Looking at the network this way can make them seem smaller since many providers practice at more than one location. This method of comparison complements the access point analysis as you continue to position your network.

Matching counts of unique locations is the methodology that carriers use in the accessibility reports they run against clients’ employee census. These reports generally show you which zip codes meet the minimum access standards. Evaluating networks this way returns the smallest counts and is usually one of the last steps in the decision-making process.

Download our whitepaper, How You Count Matters As Much as What You Count  for more detail on how to make accurate, effective provider network comparisons.

Tags: health insurance, health care providers, counting method, access points, unique providers

Measuring the Performance of the US Health System

Posted by Laura McMullen on Thu, Jun 01, 2017

Healthcare spending represented 17.8% of US GDP in 2015. What are we getting for our money? The Kaiser Family Foundation and Peterson Center on Healthcare are trying to find out.

US healthcare.jpgThe newly redesigned dashboard added to the US Health System Tracker makes it easier for people to find the latest quality, spending, access, and outcome metrics describing the US health system. According to the announcement, the dashboard shows an overview of the system’s performance compared to other similar countries as well as analysis of specific indicators measuring health and wellbeing, quality of care, health spending, and access and affordability.

The Tracker first launched in 2014 as a partnership between the Kaiser Family Foundation, a leader in health policy analysis and health journalism, and Peterson Center on Healthcare, a non-profit organization that searches for innovative solutions that increase quality and reduce cost in healthcare and accelerates adoption nationwide.

The latest brief based on the Tracker data is US health system is performing better, though still lagging behind other countries. Here are some findings that focus on the cost of healthcare:

  • The uninsured rate among nonelderly Americans dropped from 18% in 2010 to 10% in 2016.
  • The percentage of adults who reported being worried about medical bills dropped 10% between 2011 and 2016.
  • The percentage of Americans who put off or didn’t seek care due to cost dropped from 13% in 2009 to 9% in 2015.
  • Health spending per capita grew 3.6% annually from 2010 to 2015.

Does higher utilization in the short run lead to healthier populations and lower long-term spending?

Tags: Healthcare, US health system, healthcare cost, uninsured

Network Analysis with Disruption Reporting

Posted by Susan Donegan on Fri, May 19, 2017

Network_Analysis_Pyramid_Cover.pngThis method of network analysis correlates historical provider utilization and claims experience for a group of employees to the providers in a different network. If you assume that a population will utilize the same set of providers at the same frequency, you can estimate the amount of future utilization that will be in-network. Disruption Reporting is also used as a predictor of future financial experience, with more in-network claims (at a discount) resulting in lower overall claims expenses.

The utilization or claim file required for this method of analysis must include demographic data for each utilized provider, to determine if that provider is in the prospective network. Ideally it would also include quantitative statistics on how much treatment each provider performed, such as:

  • Submitted claims (number and/or amount)
  • Paid claims (number and/or amount)
  • Number of procedures performed
  • Number of patients treated

This type of utilization or claim file is generally only available when the company requesting it has at least 200 employees enrolled in that benefit plan.


There is tremendous variation in the format and quality of the utilization and/or claim data files that are included with requests for disruption reports. Unfortunately, it is very common for key provider identifiers to be omitted:  

  • Tax Identification Number (TIN)
  •  National Provider Identifier (NPI)  
  • State license numbers 

In addition to the variation in the utilization and claim data files, there is a tremendous amount of variation in the matching criteria used when these reports are produced. When some networks use looser criteria than others, employers and employees don’t get a clear picture of network access.

Download our whitepaper, The Network Analysis Pyramid for an overview of the most widely used methods to analyze provider networks.

Tags: disruption reporting, data analysis, provider networks, claims data, repricing analysis, discounted fees, network analysis

The Role of Repricing Analysis

Posted by Susan Donegan on Thu, May 11, 2017

Network_Analysis_Pyramid_Cover.pngRepricing Analysis is the least frequently available network analysis method by a wide margin, but when it is available, it is a very good predictor of future financial experience. Repricing Analysis begins with Disruption Reporting, but goes a step further. Once an in-network provider that matches a record in the claim file is identified, the discounted fee arrangement under which that provider is contracted is applied. For out-of-network providers, the reasonable and customary (R&C) charges for the area are applied. Reports from different networks are compared based on the overall cost of the claims for all providers (in-network and out-of-network) and the amount of savings each network would achieve.


Because Repricing Analysis is an extension of Disruption Reporting, all of the considerations that affect Disruption Reporting affect Repricing Analysis in the same way.

In addition, Repricing Analysis requires an extremely detailed claim file. In order to apply the discounted fees, the file must include a record for each procedure performed by each provider.

Are you using repricing analysis to help win new business and save retention threats? 

Download our whitepaper, The Network Analysis Pyramid for an overview of the most widely used methods to analyze provider networks.

Tags: disruption reporting, data analysis, provider networks, repricing analysis, discounted fees

What Gets Measured Gets Managed - Net Change and Total Change

Posted by Susan Donegan on Fri, Apr 28, 2017

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.  

net change.jpg

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.)

total change.jpg

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.

Tags: network growth, compare networks, health insurance, network productivity, healthcare providers

Healthcare Jobs Continue To Be The Best Jobs

Posted by Laura McMullen on Thu, Apr 13, 2017

The 2017 U.S. News & World Report rankings of the best jobs in the US are out and 8 of the top 10 are healthcare providers. Dentists are back on top after slipping to second after orthodontists in 2016; anesthesiologists and psychiatrists fell out of the top 10. Nurse practitioners moved up the most spots (from sixth to second) and orthodontists moved down the most (from first to fifth).  

Here’s the Top 10:  

best jobs_table.jpg(Statistician was fourth and computer systems analyst ranked eighth to round out the Top 10. Click here for the whole list.)

Healthcare jobs have dominated the top 10 for the last few years with solid demand, high job satisfaction, and strong salaries. Like last year, dentists, nurse practitioners, and physician assistants make up the clear majority of the projected demand. All three are generalists who offer treatment to people of a variety of ages on a routine basis. The rest of the providers in the list are specialists who provide care for people with specific needs.  

NetMinder Shows More Specialists Are Joining Networks

Generalists are in higher demand with more open positions overall. Interestingly, NetMinder shows that generalists are being added to provider networks more slowly than specialists.  

  • The number of general dentists who participate in national provider networks grew 11% between March 2016 and March 2017 while dental specialists grew 24% in the same period. 
  • The number of primary care physicians in broad, national networks grew 11% during the same period while specialists grew 15%.  

Two possible reasons for this are (1) specialty care costs more so carriers are motivated to add specialists to their networks and (2) there are more specialists than generalists. Medical networks are more mature than dental networks, which explains the slower growth rate of medical specialists in networks. 

The overall demand reflects the increased need for healthcare services in the US. Factors contributing to this need are: 

  • The aging of the US population. By the year 2040, about 22% of the population will be over age 65, per the US Administration on Aging. And we’re living longer: the Census Bureau reports that the average time to live for those turning 85 increased from 5.5 years in 1972 to 6.5 years in 2010. 
  • The shortage of doctors and nurses. Rigorous, lengthy, and expensive training requirements and the aging of the workforce plus unsatisfactory working conditions make these professions less attractive to young people. Some shortages result from faulty geographic and specialty distribution of healthcare professionals.  

While the greater demand for generalists is in line with the triple aim of the Institute for Healthcare Improvement: improve the patient experience (including quality and satisfaction), improve the health of populations, and reduce the per capita cost of health care, the shortage of specialists is also being felt. 

Demand For Specialized Healthcare Providers Small But Significant 

As we’ve seen in other years, the absolute number of professionals needed in these specialty fields is low, i.e. orthodontists, oral surgeons, and nurse anesthetists. Yet, the demand represents a significant percentage of the workforce and the training programs are long and rigorous requiring long lead times to fill openings. Many of these professionals serve limited populations during occasional periods with time-consuming or high-risk services which also suppresses demand resulting in a few openings with high rewards.  

All eight have similar satisfaction rankings and unemployment rates with the major differences in demand and salary possibilities. As in past years, the rankings take compensation, flexibility, opportunities for advancement, market demand, amount of stress, and skills or training required into consideration. See the methodology here

How are you addressing these supply and demand trends in your network development plans? 

Tags: Medical, dentists, network development, best jobs, healthcare providers, medical specialties, healthcare jobs

A Peek At Dental and Vision Network Trends

Posted by Susan Donegan on Wed, Mar 29, 2017

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.

AvgNetworkSize.jpgRelatively 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. 


Tags: dental network, health insurance, Vision insurance, vision networks, dental provider, practicing locations, counting method

Retail Chains In Vision Networks

Posted by Laura McMullen on Fri, Mar 10, 2017

I just saw an article about Walgreens piloting an optical shop at one of their stores in Chicago in Drug Store News. Walgreens already sells reading glasses and contact lenses already so why are they adding more services now? 

glasses_contacts.jpgThe vision care market is all about the materials. According to the Vision Council of America, three out of four Americans need glasses or contact lenses. The cost of glasses ranges widely depending on a consumer’s preferences and prescription. CostHelper Health reports a national average of $196 with lows starting at $8 for drugstore “cheaters” to highs of $600+ for designer frames with special lenses and coatings. All About Vision estimates that contact lenses cost “roughly $220 to $260 for a year's supply of lenses and another $150 to $200 on contact lens solutions, for a total annual cost of roughly $370 to $460 to wear contact lenses.”  

These costs make insurance attractive to consumers. The CDC estimates 58% of people with private insurance have optional vision coverage and 44% of people with public insurance have optional vision coverage. And vision networks are growing – here’s a summary of some trends that we’re seeing in NetMinder 

A unique component of vision networks is retail chains. In NetMinder, we define these chains as having at least 4 locations with or without an ophthalmologist or optometrist on site. When analyzing vision networks, we found that nearly 20% of locations in national vision networks are part of a national retail chain with the largest concentrations in the WalMart, Lenscrafters, and Vision Source brands.  

And this is where Walgreens comes in. Retail chains account for more than half of the revenue in the vision market even though they are only one-third of the locations. The brands are popular and heavily advertised and some competitors, WalMart and Target, area already in the market. Walgreens has more than 8,000 stores in the US and, as of August 2016, 76% of the US population lives within 5 miles of one.  

How does this potential new retail network affect your network? Is it a prospective partner? A competitor? 

Tags: vision market, optical retail, Vision insurance, vision networks, vision discount plans

Growth Trends Continue in Vision Networks

Posted by Laura McMullen on Thu, Jan 12, 2017

Each year, we analyze the vision network data in our database and publish the results. Take a look at what we learned last year. Like 2015, 2016 brought growth across the board in the 10 largest vision networks: more providers in more networks that look more alike.

top 10 vision 2016.jpgOver five years, access points grew the most, 50%, followed by unique providers at 32% and unique locations at 13%. Two possible reasons for the lag in location growth is that retail locations, such as big-box stores and wholesale clubs, offer more revenue with fewer providers and online options to fulfill eyeglass and contact lens prescriptions are increasing.

The average number of locations per provider remained about the same year over year – 2.36 vs. 2.32. This is probably a reflection of network consolidation: Superior Vision completed the integration of the Block Vision network late in 2016.

Another measure of growth that we’ve been tracking for several years is the number of networks the average provider participates in. On average, providers belonged to 3.6 networks in 2016, which is slightly down from 3.7 in 2015, and an increase of 17% in the last five years. Eye care providers (ECPs) belong to less than half the number of networks as dentists (8.3 networks in 2016) which is most likely another reflection of the consolidated nature of the vision market compared to the dental market.

vision per provider 2016.jpgThe final trend we analyze is the distribution of providers by the number of networks they participate in. In 2016, 35% of ECPs are in 4-6 networks while only 23% were in 2011. The shift from accepting 1-3 networks to 4-6 for ECPs leads to greater overlap between vision networks causing less disruption if employer groups opt to change networks.

How are these trends affecting your business? When you talk to ECPs, are they more interested in joining your network than they have been in the past? How are you maintaining the uniqueness of your network?

Tags: vision market, Vision insurance, vision networks, practicing locations




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