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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

Minimize Disruption by Maximizing Overlap

Posted by Susan Donegan on Thu, Aug 10, 2017

In order to minimize disruption for potential new clients, a dental plan needs to maximize its overlap with competitors' networks. In other words, they need to have as many of the same dentists as possible. What might be a manageable task when aiming to match up with a single competitor, this gets quite challenging for a plan with 8-10 significant competitors.network overlap.jpg

In the chart above, the blue circle represents Network A, a middle-of-the-pack network among the Top 15 dental PPO plans, while the gold circle represents the average of all of the Top 15 dental PPO plans. Network A, though quite large, only overlaps with its peers at a rate of 57%. This means that while 6 out of 10 access points in Network A's network are likely also to be in any given competitor's network, 4 out of 10 are not, and will potentially cause disruption for a prospective client. The challenge for Network A, as it is for all dental plans looking to grow, is to maximize their overlap with key competitors so that potential clients will experience minimal disruption when switching to their plan.  

Download our whitepaper, Recruit Smarter, Not Harder to learn how NetMinder data can help you target and recruit dentists more successfully and efficiently. 

Tags: disruption reporting, network disruption, network overlap, market comparison, health insurance

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.

Considerations

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

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.

Considerations

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

Estimating Network Disruption

Posted by Laura McMullen on Fri, Mar 18, 2016

Network disruption is an important consideration to an employer group planning to change insurance plans. People are attached to their doctors. A 2014 Becker’s Hospital Review/Survey Monkey survey asked people “how much they would have to save on premiums to choose a plan that forces them to change their primary care physician. The median response was a savings of $100 a month, but some people would ask for a lot more, including 28% who would want to save at least $200 a month.” 

That’s why disruption reporting is an integral part of many negotiations. Part of the plan selection process for large groups or self-insured groups is to run a disruption report using past claims experience to estimate savings in the proposed plan. But what do you do when you don’t have the claims data for a formal disruption report?

Using the Network Overlap report to evaluate disruption is a great option for smaller groups where the decision timeline is short and claims data unavailable.

disruption_graph.pngWhat does the Network Overlap report show?

This report compares two networks side-by-side, providing total, overlapping, and non-overlapping counts for each of the two networks by geographic area and specialty. ZIP codes with high overlap percentages will have less disruption than ZIPs with high unique percentages.

How does it work?

Upload your file using the UPLOAD ZIP CENSUS option in the geographic scope selection box and make the rest of your choices as usual to get started.  Running this report with custom census geographies simplifies your analysis:

  • Understand disruption for all employees in the same report. All of the ZIP codes in the file will be included in your report – even if they are not all in the same state.
  • Clarify network access in and around home and work locations. The report will return for the networks and specialties you select in the counties that contain the ZIP codes in the census file. For example, if 33433 and 33313 are in your census, the report will show Florida as the state and results in Palm Beach and Broward counties. Be sure to subtotal your report by ZIP5 to see the results for each ZIP code separately.

There aren’t too many opportunities to sell health insurance to a company that isn’t currently offering it to their employees. Demonstrating minimal network disruption can be the difference between a successful takeaway and a lost bid.

How do you estimate network disruption for current and prospective customers?

Tags: health insurance, disruption reporting, network change, ZIP codes and cities, network overlap, network disruption

4 Network Metrics to Help Make Your Network Stand out from the Crowd

Posted by Laura McMullen on Wed, Aug 26, 2015

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
Apples_ResizedBut 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?

Tags: compare networks, network metrics, health insurance, network comparison tool, disruption reporting, network change, provider networks, employee benefits

Five Best Practices to Find the Right Provider Network for Your Customers

Posted by Laura McMullen on Thu, Jul 24, 2014

In a recent blog post entitled, Five Best Practices to Use Network Data and To Grow Your Business, we wrote about the ways carriers and network leasing companies can improve their position in network comparisons by better cleaning their data. Another point of view is from the brokers and consultants who use network analyses to help their customers choose the right benefit plans.

health insurance plansShopping for employee benefits is complicated and time consuming. Employers and other plan sponsors typically rely on a broker or consultant to help them through it. Brokers and consultants know that network issues can turn a satisfied customer into one that goes out to bid in the blink of an eye. Even if everything else is right: price, benefits, service, and timely and accurate claims payments can’t outweigh a network that doesn’t fit the employee population.

As we pointed out in our other post, the best networks:

  • Offer a wide range of choices: multiple general and specialty providers are included in the network
  • Are convenient to use: providers are located near home or work
  • Include popular providers and facilities: providers are the ones that members and their families want to use
  • Save employers and employees money: in-network providers offer meaningful discounts that reduce out-of-pocket expenses and claim costs

Depending on the number of employees your customers have, different types of network analyses are probably available from your carrier partners. Generally, we see four types of network analysis:

  • Network Counting – measure the quantity of providers in each network (available for groups of all sizes)
  • Accessibility Analysis – correlate network provider locations to employee home and work locations (available for groups of all sizes)
  • Disruption Reporting – match historical provider utilization and claims experience for a group to the providers in a different network (available for groups with at least 200 employees)
  • 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 (available for very large or self-funded groups)

Download our whitepaper, The Network Analysis Pyramid, to learn more about each method.

As the primary users of network analyses, brokers and consultants are in a unique position to influence the requirements of each type of analysis. Keep these five best practices in mind as you work with carriers on your customers’ behalf:

  1. Insist on clean, accurate data so you get clean, accurate reports.
  2. Clearly identify required fields and formats in all file requests.
  3. Obtain claim data from the incumbent carrier whenever possible.
  4. Choose a consistent counting method for all reports to ensure that you are comparing apples to apples.
  5. Evaluate key specialties separately from the overall network based on your client’s needs.

With all of the changes from the Affordable Care Act, employers and other plan sponsors are relying on brokers and consultants more than ever.

How do you evaluate networks today?


 

Tags: Healthcare, healthcare reform, Affordable Care Act, health insurance, health reform, data management, data analysis, network providers, health insurers, dental network, ACA, market comparison, network metrics, compare networks, healthcare exchanges, network comparison tool, network change, provider networks, disruption reporting

Five Best Practices to Use Network Data to Grow Your Business

Posted by Darrin Hall on Thu, Jun 26, 2014

There are many factors employers consider when selecting an insurance carrier: price, benefits, service reputation and, to an increasing level of scrutiny, provider network. Positioning your provider network as the best fit for a client or prospect can make all the difference in winning the business.

Provider networks have to satisfy customers and members on multiple levels: 

  • Wide range of choices: multiple general and specialty providers are included in the network
  • Convenient to use: providers are located near home or work
  • Include popular providers and facilities: providers are the ones that members and their families want to use
  • Cost-effective: in-network providers offer meaningful discounts that reduce out-of-pocket expenses and claim costs

Because the provider network is hard to measure and so important to winning and retaining business, the industry has developed four types of network analysis:network analysis pyramid

  • Network Counting – measure the quantity of providers in each network
  • Accessibility Analysis – correlate network provider locations to employee home and work locations
  • 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

Download our whitepaper, The Network Analysis Pyramid, to learn more about each method.

Insurance companies and network leasing partners are both the source of the data in these reports and the consumers of the analyses during their sales processes. This dual role provides incentive to invest the resources needed to prepare and maintain network data so that they are in the best position to win new business.

So, what can you do to show your network in the strongest position?

Here are five best practices for managing your network data that will give you the best results in your network comparisons.

  1. Review your directory data regularly. Be sure that provider names, addresses, and phone numbers are up to date. Transparency in your reporting will be to your advantage in the long run.
  2. Check for duplicate records that can be consolidated, especially if you are stacking networks, since it can be hard to identify providers from the vendor network that are already in the carrier network.
  3. Adopt data standardization practices, particularly for numeric fields. For example, make sure leading zeroes on ZIP codes have not been dropped and replaced by the first digit of the ZIP+4. This is common in ZIP codes in New England, New Jersey, and US Caribbean territories.
  4. Consider including competitor network data in your analyses so that you understand your competitive position, predict results, and prepare for the future.
  5. For Disruption Reporting and Repricing, make sure that provider name data is properly parsed and address data is standardized. Use the same processes for claim and provider data files to give best chance of identifying valid matches.

Earning new business and retaining current customers are the lifeblood of every company. Improving your position by cleaning and maintaining your network data can make it easier to do both.

What process do you use today to manage your network data?

 

Tags: health insurance, network providers, network comparison tool, network management, provider networks, network data, disruption reporting, insurance companies, network leasing companies

 

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