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.  

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.)

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.

This question has been around since the first time someone decided to compare two provider networks. In fact, NetMinder wouldn’t be here without it! One of our founding principles is a commitment to comparing apples to apples. This thread runs through all our processes starting with the way we collect data and ending with selecting report criteria. We’re focused on this idea because we know that how you count network providers can make a big difference in calculating network strength. Read our whitepaper about counting providers.

Choosing The Best Counting Method For Your Analysis

Each counting method has strengths and weaknesses. Access points is the broadest count with the highest numbers. It’s great for showing consumers where they’ll be able to access care. Unique providers (sometimes called “belly buttons”) is often the cleanest count and preferred by benefits decision-makers. It’s not so good for consumers since it doesn’t show all locations. Unique locations (sometimes called “doorbells”) is the narrowest count with the smallest numbers for obvious reasons.

One Report To Show Them All

Making sense of these options is why we added a new Dental Dashboard to our suite of snapshot reports. It shows all three counting methods plus validated counts and percentages for a single geographic area in the same report. The six bar charts bring access points, unique providers, and unique locations together for up to five networks. Watch this video to learn more.

Each counting method is important at different points in the sales and renewal process and the Dental Dashboard makes it easier to look at them all. For example, access points are important to consumers when they are making appointments while HR teams rely on unique providers to compare networks. This report helps you prepare for questions about both scenarios and encourages a broader view of the reliability, convenience, and strength of your network.

How are you counting and comparing the providers in your network?

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. 

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?

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.

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.

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.

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.  

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.)

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.

Critical Capabilities for Better Network Comparisons

Product, sales and network teams’ needs are deeply intertwined — and success for each team relies on the ability to find the edge against competitor provider networks. When high-level comparisons suggest networks are the same or no advantage appears, that’s your cue to dig deeper.

Based on our work with more than 50 healthcare companies (and their aggregate 4,500 users), we offer 10 metrics that are critical for making more effective comparisons — which ultimately means designing better networks and selling more effectively against your competition.

The “Must Have” Capabilities for the Three Major Counting Methods

When you compare networks, how you count really matters. Different comparisons return different results, and are useful for different purposes. Selecting the right comparison method is key to your network development strategy, and to helping clients make better decisions.

In most cases, you’re counting by access points, unique providers and unique locations. Take a look at our whitepaper, How You Count Matters as Much as What You Count, for tips about choosing the right counting method for your analysis.  

10 Key Data Points You Must Have

Let’s add an overlay to the capabilities that drive the three effective counting methods — 10 metrics that must be pinpointed for your network development and sales efforts to make meaningful comparisons:

1. Which network has more unique providers?
2. Which network has more access points?
3. How truly similar are the networks you compared? (In other words, how many providers are in both networks?)
4. How many of each specialty category does each network have?
5. Based on member demographics, which specialties are most important in this situation? Which network has more?
6. How many providers in each network are within an X-mile radius of the locations where your group lives and works? Your radius might be smaller for urban ZIP codes and larger for rural ZIPs.
7. How many locations/provider are in each network? When this ratio is high, directory inflation could be present.
8. How many providers/location are in each network? When this ratio is high, large practice negotiations could disrupt the network.
9. Has the network grown or shrunk overall during the last year or six months?
10. What type of recruiting activity has there been recently? Adding new providers or replacing providers?

If you cannot decisively answer the 10 questions above, you may be missing key opportunities in network development or sales. You would not be alone in this regard: many competitive network data providers exist, but most provide cosmetic ease of use at the cost of more flexible and powerful reporting options.

If you find your teams hamstrung in their quest to make more effective comparisons — and ultimately drive more profitable activity at every level of your organization — click here and get in touch with us. We’ll talk about a better way to find and capitalize on critical points of difference.

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

But not every selling situation calls for a report. Sometimes all you need are a few metrics to catch someone’s attention so that you can have a larger discussion about why your plan is a good option for a group. Here’s a look at four network metrics that can help you make your network stand out:

1. 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.
2. 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.
3. 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.
4. 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?

Health insurance CO-OPs (Consumer Owned and Operated Plans) are part of the Affordable Care Act. More than 400,000 people enrolled in CO-OP plans during the first open enrollment period for Obamacare, and CO-OP managers are taking steps to increase enrollment. Their plans are the lowest-cost silver plans on the exchanges in nine states after cutting rates based on their experience in the first enrollment period, according to the National Alliance of State Health CO-OPs.

There are 23 non-profit CO-OPs in 26 states and all were started with 5-year loans from the federal government. Once the loan is repaid, the CO-OP is owned jointly by the private investors and members. All of the CO-OPs are members of NASHCO, the National Alliance of State Health CO-OPs. Their purpose is to provide health insurance to individuals and small businesses that have a hard time getting coverage, particularly in markets where a single insurer is dominant. This puts CO-OPs directly in competition with many Blues plans.

Most CO-OPs contract with providers directly and supplement with leased networks that wrap around their proprietary networks while a few lease or direct contract exclusively. This mix of leased and direct-contract networks is very similar to traditional commercial health insurers.

• Leased networks: Arches Health Plan (UT) leases the Coventry network and Colorado HealthOP leases the Cofinity network
• Combination of leased and direct contract: Consumers Mutual Insurance of Michigan (MI) combines proprietary networks with Multiplan, PHCS, and Cofinity wrappers and HealthyCT has a proprietary network with PHCS out of state wrapper.
• Direct contract: Kentucky Health Cooperative and New Mexico Health Connections

So far, CO-OPs have chosen to differentiate themselves through care management and outreach to members instead of following the narrow network trend. “Our whole strategy has been to invest heavily in medical management because at the end of the day, we can’t make money the way we used to, which is to conservatively underwrite this population,” says Martin Hickey, MD, CEO of New Mexico-based Health Connections and board chairman of the National Alliance of Health Care CO-OPs, in AIS Health Business Daily on Jan. 6, 2015. Typical hospital readmission rates for a commercial population are between 12% and 14%. Hickey says his firm’s readmission rate has held at 6.5%, and dipped to 2.5% over the last three months.

Like all businesses, CO-OPs live and die by their balance sheets. In January 2015, the Iowa Insurance Commissioner found that CoOportunity Health, an Iowa-based health insurance company, was insolvent and requested liquidation in court. Current members were notified and encouraged to enroll with different carriers prior to February 15 to ensure continuous coverage and compliance with federal law.

Are CO-OPs part of the network landscape in your state? Do you compete with them for customers and/or providers?

 

Competitive network data is valuable to a variety of people in the employee benefits industry. The most common uses we see are sales people comparing networks for a current or prospective customer or broker, or network managers building recruiting lists. Some marketing departments use competitive network data in collateral and strategic planners use it to help chart the way forward.

This wide variety of users has an equally wide variety of preferences. Like many other systems that include geographic analysis, NetMinder uses standard groupings – from the whole country down to a single five-digit ZIP code – to make it easy to match up with other datasets such as procedure-level cost data, membership counts and employee populations. But sometimes you need to slice the data a little bit differently. Maybe you have sales regions that include several states or underwriting zones made up of three-digit ZIP codes. That’s why we added custom geographies.

Here’s what custom regions (groups of states) look like in NetMinder. In this example, the client included 6 states in their Mid-Atlantic region:

You can also set up groups of three-digit ZIPs as markets and groups of counties as territories. There’s no limit to the number of custom geographies NetMinder can support.

Customers love the flexibility custom geographies add to NetMinder. The business information lead for a large national dental insurer tells us: “It is helpful because we are able to focus our reports to match our internal geographical breakouts. We could run the same reports by choosing the 3-digit zip codes that correspond to each area, but having them already grouped for us saves a great deal of time. It also allows us to combine multiple geographical groupings into one report. It is a very beneficial tool for how we do business.”

Some other uses for custom geographies that we’ve found are:

• Focused recruiting efforts
• Evaluating network capacity and competitive position to support sales prospecting programs in defined geographies
• Reporting on network size or makeup in service areas for regulatory and compliance needs

How do you group geographic data when you compare provider networks? What other pieces of data are important to your analysis and how do you match the datasets up?