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The NetMinder Blog

Which Counting Method Should You Choose?

Posted by Susan Donegan on Thu, Jun 08, 2017

apples to apples.jpgClients and brokers expect to see an “apples-to-apples” comparison of price and benefit design. NetMinder lets you do the same for networks. Choosing your counting method ensures that you always know what you are counting.

Comparing access points is important at the beginning of the evaluation process because it gives you the most granular view of each network. The networks look largest through this lens because each provider at each location counts as one access point. This view includes all locations that each provider could practice at, even if he or she doesn’t see patients there regularly. To avoid this problem, use the unique provider counting method.

The count of unique providers is the clearest count of contracts that each network has. Looking at the network this way can make them seem smaller since many providers practice at more than one location. This method of comparison complements the access point analysis as you continue to position your network.

Matching counts of unique locations is the methodology that carriers use in the accessibility reports they run against clients’ employee census. These reports generally show you which zip codes meet the minimum access standards. Evaluating networks this way returns the smallest counts and is usually one of the last steps in the decision-making process.

Download our whitepaper, How You Count Matters As Much as What You Count  for more detail on how to make accurate, effective provider network comparisons.

Tags: health insurance, health care providers, counting method, access points, unique providers

CO-OPs: a new twist on traditional insurance?

Posted by Laura McMullen on Fri, May 15, 2015

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

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.

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?


Tags: compare networks, health insurance, narrow networks, Affordable Care Act, insurance companies, health care providers, health insurance co-ops

Best jobs in the US are health care providers

Posted by Laura McMullen on Tue, Feb 10, 2015

US News and World Report released its 2015 list of the 100 best jobs in the US and just like in 2013, dentists have come out on top. It’s not surprising since there continues to be strong demand for dentists, salaries are high, and current dentists report high job satisfaction. What’s new this year is that other health care providers have joined dentists at the top of the list.

All seven health care jobs have similar rankings and unemployment rates with differences in levels of demand and salary possibilities. Click here to learn more about the methodology US News used.


(In case you are curious, the other three jobs in the top 10 are software developer, computer systems analyst, and information security analyst. See the rest of the top 100 here.)

The high demand numbers and low unemployment rates for these jobs are not news to anyone who has been paying attention to the healthcare industry recently. In fact, the Health Resources and Services Administration within the US Department of Health and Human Services predicts a shortage of 20,400 primary care physicians by 2020, if the system for delivering primary care stays the way it is, in their 2013 report Projecting Supply and Demand for Primary Care Practitioners through 2020. According to their estimates, even with nurse practitioners and physician assistants integrated into the delivery system, the national shortages will become less acute although supply and demand will vary regionally.

Publicity like the US News list and other media coverage of the employment outlook in healthcare highlights the good news and bad news for insurers, employers, and consumers:

  • As more people enter these fields, everyone will benefit from more choice in providers in the long run.
  • According to the American Dental Association 2010 Survey of Dental Practice, solo practitioners make up about 59% of all dental practices. While this number has declined from a high of 67% in 1991 according to a study in the Journal of Dental Education in August 2012, dentists and dental hygienists are still likely to start or join private practices which will increase the number of access points in dental networks
  • Physicians, registered nurses, nurse practitioners, physician assistants, and physical therapists tend to join large practices or work in hospitals or other facilities because medical practices are more likely to be set up as corporations for tax and liability protection. Therefore, fewer access points will be added to medical networks but there will be more providers at many locations.
  • Start-up costs are high and training timelines are long so we will likely experience shortages on the way to more choice. Nurse practitioner training tuition costs range from $22,500 to $45,000 depending on the program and takes between 12 and 18 months. Physician assistant training is approximately twice the cost and twice the time. The cost of nurse practitioner and physician assistant training is comparable but the time commitment is just a fraction compared to the cost and timing of physician training: $35,000 to $55,000 depending on the school and four years plus three to seven more for residency at a minimum. Other considerations are the number of seats in nursing and medical training programs and the number of qualified applicants.

In general, supply and demand for healthcare providers are not in sync. It’s clear the US population will continue to age and grow. How are you addressing these needs in your network development plans?

Tags: health insurance, network management, dentists, health care providers, network development




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