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The NetMinder Blog

The Fine Line Between Differentiation and Disruption

Posted by Laura McMullen on Thu, Nov 16, 2017

Switching networks can be rough, as the Texas Employees Retirement System found out when they switched to a Blue Cross Blue Shield of Texas HMO plan after using United Healthcare for several years. The Texas Blues plan uses the HealthSelect network which was designed for large groups offering ample coverage in Dallas, Houston, and other big cities. In rural areas, the Blue Advantage network, designed for small groups and individual plans, would have been a better fit, according to local experts. Blue Cross Blue Shield of Texas has moved quickly to address the network gaps. Members who are more than 30 miles from an in-network PCP or more than 75 miles from an in-network specialist can request network gap exceptions. Click here to read the Health Business Daily story that has more details from November 6, 2017. (registration required)

This type of situation happens all the time in the employee benefits industry. A network looks like it matches a group’s locations but when members start making appointments there are gaps. Minimizing network disruption to avoid employee dissatisfaction is often a big factor in making changes to the overall benefits package. Estimating disruption is one of the most common uses of NetMinder.

disruption.jpgCarriers have taken different approaches to managing the inevitable disruption that comes with changing benefit plans and networks.

  • Dental benefits companies frequently “stack” multiple lease partners on top of their direct contract network. Since many lease partners are working with multiple carriers, these networks are very similar which reduces disruption.
  • Vision benefits companies are starting to work with multiple lease partners which reduces disruption when moving between networks as well. Additionally, vision networks rely heavily on retail chains such as Target, Wal-Mart, and JCPenney which also reduces disruption.

Broad medical networks are alike due to the nature of employer-sponsored medical insurance: very few people decline it when offered and virtually all doctors accept insurance because costs are high and utilization is virtually guaranteed over a lifetime. Narrow networks, however, have introduced a new element of disruption into the medical network marketplace. As they continue to evolve, it will be interesting to see what tools and strategies are developed to minimize disruption and dissatisfaction caused by changing plans and doctors while keeping costs down.

How are your networks different from your competition? How do you measure and track the differences?

Tags: medical networks, disruption reporting, network disruption, employee benefits, dental benefits, Vision insurance, healthcare benefits

Dentists participating in more networks than ever

Posted by Laura McMullen on Thu, Jun 18, 2015

When we completed our annual review of dental PPO network trends based on the network data in NetMinder, two things really stood out:

  • The average dentist participates in 8 of the top 15 national dental PPO networks. 
  • Since March 2011, the number of dentists in more than 11 networks has grown by 15 percentage points.

dental_combo-1

The driving force behind these numbers seems to be the proliferation of lease and swap arrangements in the dental benefits industry. A dentist joins a network and then that network is leased to several other carriers so the dentist is now in multiple networks.

These arrangements enable rapid network growth by adding large groups of dentists at a time and make it easier to match competitors. In the past, dental benefits companies partnered with network leasing companies, such as DenteMax or PPO USA. Now we are seeing carriers swap networks like United Concordia and DNoA.

Maximizing the overlap between carriers is a sound strategy in a market where takeover business is predominant. Since the 2014 NADP State of The Dental Benefits Market study shows that 61% of Americans have dental insurance, this seems like the right strategy for right now.

How are these larger dental PPO networks playing out in your book of business?

Tags: dental network, network data, dental PPO networks, dental benefits, dentists

How the Affordable Care Act (ACA) is Influencing Adult Dental Insurance Coverage

Posted by Laura McMullen on Thu, May 15, 2014

Adult dental insurance is a hot topic thanks to the Affordable Care Act (ACA) and Healthcare.gov. Under the new healthcare law, dental coverage for children 18 and younger is considered an essential health benefit that must be included in all plans sold on exchanges. For adults, it’s a different story: insurers don’t have to offer adult dental coverage, nor do adults have to purchase it.

dentistsThis situation could lead to fewer healthy adults purchasing dental coverage because their health insurance budget is committed to the mandated ACA coverage. This effect may drive up dental premiums for everyone if the pool of prospective purchasers consists only of those needing more extensive and costly dental treatments. From a network perspective, dentists may find themselves joining more networks to fill in the gaps and gain new patients.

Nancy Smith lays out the ramifications of ACA on adult dental coverage and concerns from dentists in this Sunshine State News article “Obamacare Leaves Gaping Cavity in Adults’ Dental Health”.

Individual Adult Dental Insurance Plans

Consumers may start looking for individual adult dental insurance plans. This is an opportunity to promote a variety of dental plans, ranging from discount plans to stand-alone insurance plans to dental benefits that are embedded in qualified health plans on exchanges. These plans can differ significantly from traditional, employer-sponsored dental plans and may require education to ensure member satisfaction.

dentist toolsFor example, “annual maximum” is an important term when talking about adult dental insurance. The annual maximum, or benefit cap, limits the maximum amount the insurer has to pay, making the consumer responsible for any additional costs beyond the maximum. Due to ACA, new health insurance policies do not include a benefit cap. However, for consumers looking for both health and dental insurance, benefit caps can still exist in adult dental plans under the name “annual maximum.”

Read more on this topic in the article “What is the Problem with Adult Dental Insurance Plans on Healthcare.gov?” by Naomi Mannino on www.mainstreet.com. Of course, consumers should check that their providers are in the network.

Voluntary Group Plans

In some cases, another option is voluntary group dental insurance. Caitlin Bronson, in Insurance Business America, reports that some groups are dropping health insurance plans so that their employees can use the exchanges but adding voluntary ancillary benefits, like dental and vision plans. She writes, “Roughly 80% of voluntary sales are dental coverage, with a projected 2% increase in 2014, Towers Watson found in its 2013 Voluntary Benefits Survey.”

These plans allow employers to offer a popular benefit and pass the cost along to their employees via payroll deduction, which in some cases eases the sting of changes in health insurance benefits. Some believe that voluntary plans don’t offer enough coverage for the cost to satisfy commercial clients and their employees.

With several options to choose from, will healthy adults opt for dental coverage?  

Tags: dental benefits, dental insurance, dental insurer, health insurance, healthcare benefits, network providers, dental network, dental providers, ACA, Affordable Care Act, compare networks

As Dental PPO Penetration Increases, Is Market Saturation Near?

Posted by Aaron Groffman on Fri, Nov 30, 2012

Our analysis of the top 15 dental PPO networks revealed another important trend: market penetration is growing, with room for more growth in the future.

Dental PPO market penetration (contracted providers as a percent of the available number of providers) continues to grow. As of March 2012, the average national PPO plan contracted with approximately 72,000 providers, representing 37.8% of available providers, up from 37.2% a year prior. By comparison, in 2008, market penetration was only 28.1%, with fewer than 50,000 providers contracted. The recent growth seems due in part to an increase in the number of networks dentists are joining.  Networks per provider increased from 5.9 in 2008 to 8.4 in March 2012.

Of course, there’s still plenty of room for growth. With nearly 120,000 providers, on average, not yet participating, we expect dental PPO market penetration to continue to increase.

 DentalPPOTrends MarketPenetration Netminder1 resized 600

Tags: dental, dental benefits, dental insurance, dental insurer, dentists, dental provider, network growth, dental PPO networks

Is Growth of Dental PPO Networks Sustainable?

Posted by Aaron Groffman on Fri, Nov 16, 2012

We recently analyzed the top 15 dental PPO networks and discovered several important trends in the dental PPO market. One of the most notable trends is that, so far, dental PPO networks continue to grow.

More dentists are contracting each year. In March 2012, the average national dental PPO network[1] contracted with more than 72,000 unique dentists, up 8.7% from the prior year. Additionally, reported access points increased 22%, much faster than the growth in unique dentists. Based on these two factors, on average, the number of locations a dentist practiced at grew from just over 2 in 2011 to 2.25 in 2012.

We’ve heard concerns that some network directories might be overstating access, so we dug deeper into the claims data provided by many of our clients.  We found that, of the average 2.25 locations per dentist that directories claim, we were able to confirm an average of 1.34 practicing locations.  A practicing location is one where there was confirmed claims activity for the dentist during the last twelve months.  As we receive more and more claims data from clients, the number of practicing locations will most likely increase.

With all this growth of dental PPO networks in recent years, we have to ask: is it sustainable?


[1] The average of the top 15 national dental PPO networks.

Tags: dental, dental benefits, dental insurance, dental insurer, dentists, dental provider, network growth

Prudential Exits Dental Benefits Market; Others to Follow?

Posted by Aaron Groffman on Wed, Oct 17, 2012

Exit dental benefits marketOver the last few years we've seen a number of new entrants into the dental benefits market.  With many options for leasing networks and outsourcing back office functions, the barriers to entry seem fairly low. So far not many carriers have exited dental. However, one of the nation’s largest insurers recently announced it is leaving the dental benefits market to focus on other products. It may be too early to tell, but this news does spark the question: Could this be the beginning of an exit trend?   

Prudential Financial Inc. announced last week that it will discontinue the sale of dental coverage and concentrate instead on its bread and butter: life and disability policies. The second-largest U.S. life insurer said its group unit, Prudential Group Insurance, will continue to service dental clients until their current contracts expire.

In recent years very few carriers have left the dental industry. But times have changed and perhaps dental is not as easy as it seems.

What do you think? Will more insurers follow Prudential’s lead and strategically eliminate supplementary lines of business to focus efforts and resources on their core products?

Tags: dental, dental benefits, dental insurance, dental insurer

 

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