network data is useful. netminder knowledge is powerful.

The NetMinder Blog

Dental PPO Network Growth Rate Down While Locations Per Provider Increased Significantly

Posted by Laura McMullen on Mon, Oct 24, 2016

Our annual analysis of dental network trends showed overall annual growth in unique providers of ~7-8% over the last five years. By all measures, networks are growing.

Here’s the breakdown:

  • The average number of unique locations grew from 58K to 77K, or 33%
  • The average number of unique providers grew from 72K to 99K, or 37%
  • The average number of access points grew from 163K to 309K, or 90%

Top 15 Dental PPOs_mar 2016.jpgNot only are there more locations and more providers, but there are also more locations per provider: up 38% (2.25 to 3.12) from March 2012 to March 2016.

And yet, when we did this same analysis in 2015, we saw 10% annual growth in unique providers over the prior five years. While the growth was higher in access points and lower in unique locations like it is this year, all of the percentages were higher:

  • The average number of unique locations grew from 54K to 76K, or 41%
  • The average number of unique providers grew from 67K to 100K, or 50%
  • The average number of access points grew from 134K to 281K, or 110%

Interestingly, the average number of locations per provider only grew 29% (2.01 to 2.82) between March 2011 and March 2015.

So if the annual growth rate is lower, and the overall growth in each counting method is less, why did the average number of locations per provider grow 33%?

The multiplier effect we were starting to see in 2015 has blossomed. Just one of the 15 largest national dental PPO networks doesn’t have any lease partners and the other 14 have increasingly more complex network stacks. On average, the largest networks have four network partners and four networks have six partners. Connection Dental, DenteMax, Maverest, and Stratose are the most frequent network partners.

Another factor is the number of networks each dentist is joining. In our analysis, we found that the average dentist participates with 55% of the top 15 dental PPO networks, while nearly half of dentists in networks are in at least 11.

One more element of the growth is the rise of dental service organizations. We’ve seen a decade of private equity investment and that’s paying off. Becker’s Hospital Review noted that a 2014 Sageworks analysis found that DPMs generated the highest return on equity of the industries it examined. With additional cash, DSOs are growing by building and acquiring dental practice. And following the industry practice of listing each provider at each office contributes to the increase in locations per provider.

How are these trends playing out in your networks and markets? About 40% of dentists participate in 1-4 networks, so there is still room for organic growth. How well are both tactics represented in your strategic plan?

Tags: network growth, dental network, network providers, dental PPO networks, counting method

Claims Data Makes Provider Directories More Accurate

Posted by Laura McMullen on Thu, Jan 21, 2016

“About 70% of plans sold on the exchanges in 2014 featured a limited network, and their premiums were up to 17% cheaper than plans with broader networks, according to a study by consulting firm McKinsey & Co.”, reported Modern Healthcare in March 2015. In response to consumer complaints about narrow networks, network adequacy regulations set criteria for distance to providers; the quantity of providers in a network; and the inclusion of essential community providers in a geographic area and, beginning January 2016, fines for inaccurate data.

Accurate provider directories are a problem for all networks. Providers retire, sell their practices, change jobs, and die, just like everyone else. It’s difficult to stay on top of this information, especially if you have several networks and/or network partners. The credentialing process, where provider credentials are reviewed at least once every three years to evaluate their practice histories and qualifications, and self-reporting are the primary methods network managers use to update their records. A 2014 study published in the Journal of the American Medical Association Dermatology found that these methods aren’t working:

  • Among 4,754 total dermatologist listings in Medicare Advantage networks in 12 US metropolitan areas, 45.5% were duplicates in the same plan directory.
  • Less than half (48.9%) of the unique physician listings were reachable, accepted the listed plan, and offered an appointment.

The Department of Health and Human Services’ Office of the Inspector General found similar results when looking at Medicaid networks in 2014. When they surveyed 1,800 primary care providers and specialists, “35 percent could not be found at the location listed by the plan, another 8 percent were at the location but said that they were not participating in the plan, and an additional 8 percent were not accepting new patients.”

Some experts suggest improving the accuracy of provider directories by including only providers to whom you’ve paid claims within 12 months. “Since 2013, New Jersey health plans must attempt to contact any provider who hasn't filed a claim in 12 months. If a provider fails to respond in 30 days, the insurers must remove that listing. Since then, ‘the number of complaints has gone down,’ says Larry Downs, CEO of the Medical Society of New Jersey,” in “Insurers Race to Avoid New Fines” on nasdaq.com.

Overstated access has been a problem in dental PPO provider directories for several years; access points are growing twice as fast as unique providers and unique locations.

top_15_dental.jpg

We’ve seen success using claims to verify locations where providers are practicing in our dental network analyses. In general, we find that about 75% of dental access points can be validated through claims analysis. Demonstrating clean data vs. your competitors is a definite advantage when selling your network to clients and brokers and also helps focus recruiting efforts, saving time and money. Learn more about our approach in our whitepaper Are Dental Provider Directories Overstated?

What steps are you taking to ensure accurate provider directories? How do you figure out which providers are really available in your competitors’ directories?

Tags: narrow networks, provider networks, dental PPO networks, medicare advantage, provider directories, claims data

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 does network leasing work in health insurance?

Posted by Laura McMullen on Thu, Mar 26, 2015

In a previous blog post, we explored the narrow network trend that began with HMOs and resurfaced on the federal and state exchanges from the Affordable Care Act. In that post we also touched on some of the new entrants into the health insurance market like co-ops and health system-based networks. This is the first of a series of posts that explores these new entrants and their network structures further.

healthinsuranceHistorically, insurance companies built and maintained their own provider networks. As the healthcare market changes, new network organizations have become more prevalent and visible and existing networks have been put to different uses. These network organizations can be categorized into six groups: network leasing companies; CO-OPs; TPAs and other cost management experts; discounters; hospitals and health systems; and accountable care organizations (ACOs).  Each of these categories has a slightly different perspective on managing provider relationships – some work closely with providers while others are at arm’s length – and it’s important to keep these differences in mind as you compare networks. This post takes a look at network leasing companies and future posts will examine the other types.

Network Leasing Companies

Many medical and dental networks use leasing partners to fill in service area gaps, meet network adequacy requirements, move into new markets, and grow their networks in general. There are two types of PPO networks that are available for lease.

Insurance companies take the financial risk for an enrollee’s medical costs and offer a network of providers who accept reduced fees for access to enrollees to control those costs. Staff at the insurance company recruit providers into the network and manage the ongoing relationships. When carriers have excess capacity in their networks, they sometimes decide to lease or swap all or part of the network to other companies. Lease arrangements earn additional revenue for insurance companies through monthly network access fees. Swaps fill in network gaps which can create a stronger sales advantage.

Examples of insurance company networks available for swap or lease:

Non-risk PPOs offer providers a fee schedule for covered services and then sell access to the network to other entities, i.e. insurance companies, employer groups, associations, unions, etc. The company offering the PPO doesn’t take the risk for the enrollee’s medical costs. The provider’s contract is with the network leasing company and the leasing entity is one step removed. The network leasing company receives a monthly network access fee for every person who can use the network, although other arrangements are possible. These arrangements are popular in medical and dental networks with standalone companies and carriers offering their networks for lease.

Examples of non-risk PPOs available for lease:

Vision networks are also leased as non-risk PPOs or offered under their own names by medical or dental carriers where the risk is taken by the vision plan. EyeMed and Block Vision are active in this space.

When leasing all or part of a network, it is important to make sure that all providers are properly contracted to offer discounts to members. When networks are “stacked,” offering multiple networks within a service area to achieve higher discounts, providers can be confused about which fee schedules are in effect. Confusion in the provider’s office can lead to member dissatisfaction if the wrong coinsurance or copay is charged which ultimately leads to lost business. When leasing, be sure your network team works closely with its counterparts in your lease partner’s organization.

How does network leasing fit into your business plan? Are you looking at new service areas? Do you have network adequacy requirements to meet?

Tags: network providers, Affordable Care Act, network leasing companies, dental PPO networks, insurance companies, vision networks, non-risk PPOs

NetMinder Snapshots and Reports: Something for Everyone

Posted by Laura McMullen on Thu, Feb 27, 2014

When I’m talking to new NetMinder users, they ask when to use the different reports. This blog post compares NetMinder Snapshots to standard NetMinder reports.

We recently launched Snapshots to give users a quick way to compare all of the networks in their subscriptions at the same time and to give insight into where one network ranks in a market against all networks in our database, even the ones that aren’t in your subscription.

To run a Snapshot, users make just three selections:
  • a geographic area
  • counting method
  • whether to compare to the networks in their subscription or to the market at-large

Snapshots, which run with just a few clicks on a single screen, work well as a complement to standard NetMinder reports, which give users more flexibility to include multiple geographic areas, choose which specialties and/or networks to include or exclude, and choose between summary counts and detailed lists.

In general, use Snapshots for high‐level overviews of provider counts and metrics in a particular area and use Standard Reports for more detailed information. Here are some examples:

 

Standard Reports

Snapshots

I want to compare counts for all networks in my subscription to each other for the whole country or a single state, MSA, or county for all specialties.

   Yes

I want to see a detailed list of provider contact information.

 Yes  

I want to compare my network to all the other networks in a market.

   Yes

I want to see the counts of adds and drops for a network since the 
previous update.

 Yes  

I want to see the counts for three networks in my subscription in five
ZIP codes.

 Yes  

I want to see the overall increase or decrease in a network since the previous update.

   Yes

Right now, Snapshots are available for dental PPO subscriptions; we plan to launch for the other products soon. Have you tried the NetMinder Snapshots yet? What do you think?

Tags: market comparison, network metrics, network rank, dental PPO networks, provider counts

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

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

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

 

CONNECT WITH US

 

NetMinder delivers industry leading network comparison tools that make your sales force more effective and your recruiters more efficient. Network data is useful. NetMinder knowledge is powerful. Learn More About What We Do

 

RESOURCES