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The NetMinder Blog

Synergies Helping the Dental and Vision Insurance Markets Work Together

Posted by Susan Donegan on Fri, Jan 26, 2018

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:

demand_dental_vision.jpg

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. 


23 https://en.wikipedia.org/wiki/List_of_dental_schools_in_the_United_States:
24https://www.quora.com/How-long-does-a-routine-dental-checkup-normally-take-in-the-U-S-if-the-patient-is-perfectlyhealthy-and-schedules-one-every-six-months
25http://www.webmd.com/eye-health/what-to-expect-checkup-eye-exam-adults#1
26 http://health.costhelper.com/teeth-cleaning.html
27 http://eyeexamcosts.com/understanding-eye-doctor-costs/

Tags: dental insurance, Vision insurance, vision networks, dental network, access points, unique providers, provider locations, practicing locations, NetMinder, network analysis, network comparison tool

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

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

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

What Is the Best Job of 2013? Dentist!

Posted by Aaron Groffman on Tue, Mar 19, 2013

Dentists have something to smile about. They have the best job in the country, according to a U.S. News & World Report study. The study ranked the top 100 jobs of 2013 based on the number of openings, the chance to advance and be professionally fulfilled, and the ability to meet financial obligations.

With an overall score of 8.4 out of 10 and an unemployment rate of just .7%, the dental profession outranked other top 10 jobs, including registered nurse, pharmacist and web developer.

Dentistry is a growing field with predicted employment growth of about 21% between 2010 and 2020, according to the U.S. Bureau of Labor Statistics. More than 27,000 job openings for dentists are expected during that time. And with a median salary of $142,740 (in 2011), it is one of the highest paying healthcare professions.

This is all great news for insurers and consumers who will benefit from more choices of dental providers and – as many will open private offices – more access points.

As of November 2012, there were more than 195,000 professionally active dentists in the U.S., as reported on statehealthfacts.org, a Kaiser Family Foundation project. A NetMinder data analysis of dental PPO trends shows that these providers are joining more insurance networks, and their number of reported practice locations is growing.

In March 2012, the average national dental PPO network contracted with more than 72,000 unique dentists, up 8.7% from the prior year. If the number of dentists in the U.S. continues to grow, they won’t be the only ones smiling; consumers and insurance companies will be glad to see more providers and more practice locations in their insurance networks.

Tags: dental insurance, dental network, dental providers

Is the Health Insurance Company a Good Friend?

Posted by Aaron Groffman on Fri, Mar 08, 2013

Medical 000005787159Medium(2)The next decade will be about bringing down the costs of health care in the U.S., says venture capitalist and blogger Todd Hixon, in a recent Forbes article titled “The Health Insurance Company Is Your Friend.” The biggest drivers of healthcare spending in the U.S. are the over-utilization of advanced medical care and the high earnings of the providers of that care, he says.

It’s payers versus providers, and health insurers are in the payers’ corner.

Hixon shares one of his own healthcare experiences in which “the insurance company paid about 30% of the face value of the bill, due to a combination of lower negotiated prices and striking off major billing errors and duplications.” 

The takeaway for insurers is that finding the right network providers is more important than ever. Insurance companies can help keep healthcare costs down by shifting away the high-end risk as well as building provider networks with good value for the cost, Hixon says in his follow-up article. Look for providers who offer good discounts, have a good utilization track record, and who participate with other networks so they know what’s expected. 

This is the right dynamic: how the insurance company becomes a better friend.

Tags: Healthcare, dental insurance, health insurance, health reform, network providers, payers, health insurers

Join Me at World Congress!

Posted by Aaron Groffman on Wed, Feb 20, 2013

World Congress logoHealth plans, insurance carriers and brokers will convene March 13-15, 2013, to learn how to leverage ancillary and voluntary products to increase their competitive edge and meet the needs of a consumer-driven market.

The World Congress 3rd Annual Leadership Summit on Ancillary Products and Voluntary Benefits will take place in Orlando and feature industry-leading speakers from CIGNA, United Healthcare, VSP Visioncare, Integrated Benefits Institute, Prudential, Blue Cross and Blue Shield, Health Plan Week and more. Session topics include meeting consumer needs, health reform, member acquisition, public and private healthcare exchanges, business innovations and other issues affecting the healthcare industry.

Join me on March 14th as I present “Using BIG Data to Get BIG Results in Ancillary Benefits.” We will explore the following ideas:

  • What’s big data? Does it apply to healthcare?
  • Learn how other carriers are using their big data to create competitive advantages.
  • Teach your sales and network teams to leverage big data to get big results.

If you'd like to attend the World Congress, be sure to register with promo code TAU676 and save $400 off of your attendance fee! (Discount is not valid toward government rates.)

I would love to see you in Orlando. Will you be attending the summit? 

Tags: Specialty Benefits, Ancillary Products, Ancillary benefits, Voluntary Benefits, Benefit Design, Managed Care, dental insurance, Vision insurance, Benefits Consultants, Insurance Brokers, Health plan, World Congress

Guest Blog: What Would Happen if Congress Taxes Health Benefits?

Posted by David Merzel on Thu, Feb 07, 2013

David Merzel of Kaufman Rossin CPAs

David Merzel of Kaufman, Rossin & Co. writes a guest blog for NetMinder about the effects of a possible tax on health benefits.

If Congress decides to start taxing employer-provided healthcare benefits as a way to raise revenue and tame the federal deficit, it could prove costly to U.S. workers, insurers and even providers.

Employees often overlook the tax-free benefits of receiving all or part of their healthcare benefits paid by their employer.  This has been referred to as the biggest tax break allowed in the U.S., far surpassing favorites like the mortgage interest deduction, charitable contributions and many other itemized deductions.

The past reaction to similar taxes has been for taxpayers to cut spending on purchases of discretionary items, such as certain healthcare benefits. In fact, recent research by the Employee Benefit Research Institute shows that more than half of U.S. workers would either drop coverage or shop around for a less costly plan should the government tax health benefits.

Dental and vision insurance have long been thought of as added perks and not as essential as primary health care insurance. If health benefits become taxable, workers might drop these additional types of coverage or they may cut back on or delay dental and vision check-ups and services, which would in turn affect insurers’ and providers’ bottom lines. 

How much would a tax on employer-based health coverage cost the average taxpayer? Let’s look at an average U.S. family of four using the following annual assumptions. The premium amounts listed below represent the employer contribution, based on an employer paying 70% of the total insurance premiums and the employee paying 30%:

Household income* $52,762
Medical insurance** $10,832
Dental PPO*** $420
Vision insurance**** $143
Effective tax rate 15%
Tax on healthcare benefits $1,709

* [Median U.S. household income—U.S. Census Bureau]
** [Kaiser Family Foundation and Health Research & Educational Trust survey]
*** [2012 Dental Benefits Report: Premium and Benefit Utilization Trends—National Association of Dental Plans]

**** [Average composite annual premium for typical insured vision plan—OptumInsight]

It’s easy to see that with a total additional tax burden of more than $1,700, optional benefits such as dental and vision coverage may be on the chopping block for the average American.  The result is a taxpayer with reduced benefits and one more obstacle for dental and vision insurers and providers, who are already feeling the pain from consolidation and price pressure.

_____

David Merzel, EA, is an accounting principal at Kaufman, Rossin & Co., one of the top CPA firms in the country. He is a New York State licensed CPA and a federally licensed IRS Enrolled Agent. David can be reached at dmerzel@kaufmanrossin.com.

Tags: Healthcare, employee benefits, dental insurance, healthcare reform, health insurance, health reform, Vision insurance, healthcare benefits

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

 

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