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The NetMinder Blog

Gauging the Productivity of Your Network Development Activities

Posted by Susan Donegan on Wed, Mar 07, 2018

When you subtract the number of providers who leave the network from the number who've joined for a time period, you get an important metric, Net Change. Net Change measures the overall growth in a network. Potential clients are looking for long-term relationships, and while losing providers isn’t positive, the ability to replace them efficiently is a strength.  

net change.jpg

In the example above, while Network A lost 8% of its providers during the time period versus only 6% for Network B, it was able to more than replace them, with adds of 14%. Network A’s net growth of 6%, compared to the competitor’s growth of just 2%, can be positioned as a clear advantage. From a management perspective, Net Change also serves well as a key performance indicator for provider relations teams.

Another important metric is Total Change, which demonstrates the amount of movement in a network or a market. While Net Change measures network growth, Total Change simply measures movement. It shows the overall change in the makeup of the network over time. Using the previous example, Network A had a total change of 22% (14% adds plus 8% drops) versus Network B’s total change of 14% (8% adds plus 6% drops.)

total change.jpg

Employed by itself, Total Change is not all that revealing. However, when combined with Net Change, it creates a powerful new metric for gauging the productivity of your network development activities compared to internal benchmarks and relative to your competition, which we call the Network Productivity Index.   

Download our whitepaper to better understand the dynamics of provider networks and measuring all of the productivity index components - adds, drops, net change and total change.

Tags: compare networks, network comparison tool, network growth, health insurance, network productivity, healthcare providers

Kaiser Permanente Hires Harvard Professor to Lead Medical School

Posted by Laura McMullen on Thu, Nov 02, 2017

medical school students.jpgThe lines of communication between doctors and insurance companies are key elements to make sure that patients get the treatment they need. Kaiser Permanente established a medical school affiliated with its hospital system with a vision “to provide a unique medical education embedded in a physician-led health care delivery system, that ignites a passion for learning, a desire to serve, and an unwavering commitment to improve the health and well-being of patients and communities.” The school broke ground in September 2017 and will enroll its first class of students in the fall of 2019.

Carey Goldberg, CommonHealth blog editor at WBUR, interviewed Dr. Mark Schuster about his plans for the Kaiser Permanente School of Medicine. Here are some highlights:

  • Students will have experience in clinical settings from the very beginning. Schuster says, “our students will be in clinical settings from the start, doing work that’s appropriate to their level of experience. They might be interviewing patients or serving as navigators for them. We want our students to understand what it's like to be a patient who is intimidated by the health care system, fearful of potential diagnoses, confused by the jargon.”
  • Courses will use a variety of teaching and learning methods. Classes will be small-group and case study-based. Spiral learning techniques will be used – introducing concepts early and returning to them regularly as students progress. Some classes will be ‘flipped’; where students watch videos, complete exercises, and read ahead of class so that class time can be spent in more interactive pursuits.
  • Graduates will contribute to a wide variety of communities. Schuster wants “students to be able to choose their field and where they practice without the constraints of the high debt that so many medical students have.” And Kaiser Permanente is providing the school with significant financial aid. Additionally, students will not be obligated to work for Kaiser Permanente after graduation. “The goal is to teach students who will spread out around the country and beyond, and take their skills everywhere and teach others around them,” said Dr. Schuster.

The Kaiser Permanente system is unique in that it is an integrated delivery system that also offers insurance. Their goal of preparing doctors who are lifelong learners, focused on health instead of disease, go beyond the clinical setting to understand patients’ needs, and use data to find gaps and solve problems who can share that knowledge throughout the healthcare system is admirable. The first class of prospective doctors will have 48 students and subsequent classes will grow to 96 students.

Is this a strategy that other public and private health insurers would benefit from? Are there opportunities for collaboration in areas like evidence-based medicine and establishing coverage in health professional shortage areas?

Tags: medical school, hospital system, health insurance, healthcare system, health insurers, healthcare providers

4 Ways to Measure Network Strength

Posted by Susan Donegan on Thu, Sep 14, 2017

The health insurance industry has developed a spectrum of network analysis tools to demonstrate a network’s breadth and depth, and to differentiate between networks.There are 4 common methods of network analysis widely used to evaluate health-related insurance products today. We visualize this spectrum as a pyramid to show how frequently the analysis is used and how specific the information is to each company. As you ascend the pyramid the frequency of availability decreases but the knowledge gained becomes more specific and as a result is more valuable to the overall assessment of the networks under consideration.4 ways to measure network strength.jpg

For example, at the bottom of the pyramid, measuring network size is fairly easy and is used in almost every analysis; it’s not very specific to a particular client or prospect. At the top of the pyramid, re-pricing the claims of the incumbent carrier is more difficult to do because it requires more data and cooperation from the prospect and the incumbent, therefore it’s done less frequently. However, when done, it’s very specific to the prospect’s situation. 

Download our whitepaper, The Network Analysis Pyramid for an overview of the most widely used methods to analyze provider networks.

Tags: data analysis, health insurance, compare networks, network comparison tool, network data, repricing analysis, provider networks

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

Studying the Accuracy of Provider Directories

Posted by Laura McMullen on Thu, Jul 27, 2017

Many people have had this experience – you’re looking for a new healthcare provider in your insurance plan’s directory and when you call, that doctor (or dentist or optometrist) doesn’t work at that location any more or the office isn’t accepting new patients. So you move on to the next name on the list and keep calling. As market forces, government regulations, and rising costs combine to focus more attention on every aspect of the health insurance industry, two recent initiatives examine provider directory accuracy.

provider-directory-4.jpg

CMS Online Provider Directory Review

In a previous post, we shared the preliminary findings from a CMS project designed to assess provider directory accuracy. CMS released the final report which confirmed that 47% of the 5,832 provider records reviewed in Medicare Advantage networks had at least one deficiency and listed the names and results of the 54 health plans involved in the audit along with the compliance actions taken. Fierce Healthcare summarized the results here.

AHIP Provider Directory Initiative

Between April and September 2016, AHIP executed a large-scale project to evaluate a variety of ways to update directory information. This issue brief summarizes the project including background on the vendors, methodology, and results of an independent evaluation by NORC at the University of Chicago. A blog post from March 2017, What It Takes to Improve Provider Directories, discussed the findings and offered potential solutions in actions that could be taken by providers and networks:

  • Provider side: enforce contractual requirements and offer incentives to providers
  • Network side: use multiple channels and media to connect with providers such as email, phone, mail, fax, and provider one source to update data for multiple plans

The prevalence of inaccurate data that CMS found and the low response rates plus lack of information about the importance of updating directory information underscore the complexity of maintaining this information. “The root cause of the problem isn’t the directories themselves; it’s the underlying data. Capturing, storing, and retrieving provider data has always been a complex process,” writes Mark Martin, Availity’s director of payer solutions, provider data management, and Dianne Wagner, senior director, provider engagement and enablement at Guidewell, in Managed Healthcare Executive.

The importance of accurate provider directories to the whole healthcare industry – consumers find providers and make appointments easily, providers earn the advertising and publicity benefits of inclusion in provider directories, and networks improve customer satisfaction, compare provider directories, and avoid compliance actions – make fixing this problem a chronic priority.

What steps are you taking to improve the accuracy of your provider directory?

Tags: provider directories, healthcare providers, healthcare system, provider networks, health insurance

Six Synergies That Make Selling Dental and Vision Plans Together Smart

Posted by Susan Donegan on Wed, Jul 19, 2017

Beyond their similar relationship to medical plans, dental and vision plans have several other synergies.

The same components are evaluated during the dental and vision benefits sales processes: benefit, price, and network. Both products have defined benefit structures that can be compared on specific points. Rates are presented in tiers based on job classifications and number of people covered. Networks are less complex than medical plans and specific tools and processes have evolved to compare apples to apples.

The same network analysis tools can be used for both products to differentiate between networks. The sales process requires size comparisons, accessibility measurements, overlap/disruption analysis, and sometimes re-pricing analysis. network analysis pyramid.jpg

Beyond the departments that all companies have such as IT and facilities management, dental and vision plans can share functions like pricing, sales, marketing, and underwriting. Many multiline carriers have shared sales forces that use a single point-of-contact as a selling advantage. There are also departments that perform similar functions like recruiting and credentialing, where process synergies can come into play.

And, distribution strategies, like whether or not to be on an exchange, broker marketing strategies, and voluntary/worksite programs, since both products are voluntary-friendly, can be leveraged across both lines of business.

Download our whitepaper,  Exploring How Dental and Vision Work Together to learn more about the synergies that help the dental and vision insurance markets work together. 

Tags: dental network, vision networks, health insurance, healthcare benefits

The Best Solutions to High Healthcare Costs Are Local

Posted by Laura McMullen on Tue, Jul 11, 2017

A new interactive mapping tool and issue brief released by the Health Care Cost Institute with support from the Robert Wood Johnson Foundation shows wide variation in prices for different categories of medical services within communities and across the country between 2012 and 2014.

map of US.png

The Healthy Marketplace Index: Medical Service Price Category Index uses annual health care claims data from over 40 million Americans under age 65 with employer-sponsored insurance which accounts for more than 25% of the commercially insured population in the US. Aetna, Humana, Kaiser Permanente, and UnitedHealthcare contribute data to this project. The information is organized by CBSA, Core Based Statistical Areas, which are commonly used geographic regions of economic integration comprised of counties.

Users can look at costs in three categories: inpatient, outpatient, and physician services. Costs rose in all three categories although not at the same rate. “Prices for outpatient services rose fastest, while physician price increases were minimal. The most consistent growth was seen in inpatient prices which increased, on average, five percent each year,” the report notes.

Other highlights are:

  • There’s a link between inpatient and outpatient price levels. The report hypothesizes that “some aspects of the drivers underlying inpatient and outpatient prices may be related, such as commonalities in labor supply or population health.” HCCI found only a minimal relationship between physician services and the other two categories.
  • Some markets are consistent in pricing across categories. For example, prices in Cincinnati are consistently below average, prices in Nashville are consistently average, and prices are consistently high in Dallas. Other markets, such as Trenton, New Jersey had average inpatient and physician prices, but high outpatient prices compared to the national averages.

Download the issue brief or try out the mapping tool to see what your key markets look like.

Tags: healthcare cost, claims data, health insurance, inpatient services, outpatient services

Insurers and ACA Marketplaces Over Time

Posted by Laura McMullen on Thu, Jun 15, 2017

We’re approaching CMS’ June 21 deadline for Qualified Health Plan applications and rate table templates for plans to be sold on healthcare.gov or the state marketplaces. So, it seems like a good time to look back over the last four years and see how the mix of insurers participating in the exchanges changed between 2014 and 2017.

ACA.pngThe Kaiser Family Foundation’s Health Reform blog has a nice summary here that includes interactive maps. Data for this analysis was gathered from healthcare.gov, state exchange enrollment websites, and insurer rate filings to state regulators.

Year by year overview

  • 2014: on average 5 insurers participated in each state, ranging from 1 insurer in New Hampshire and West Virginia to 16 in New York.
  • 2015: on average 6 insurers participated in each state, ranging from 1 in West Virginia to 16 in New York.
  • 2016: on average 5.6 insurers participated in each state, ranging from 1 in Wyoming to 16 in Texas and Wisconsin. The mix of carriers in each state changed a lot in 2016 as CO-OPs failed and new plans entered the market.
  • 2017: on average 4.3 insurers participated in each state, ranging from 1 in Alabama, Alaska, Oklahoma, South Carolina and Wyoming to 15 in Wisconsin.

Other findings from the analysis

  • There are fewer choices in most counties. In 2017, 58% of enrollees (living in about 30% of counties) had a choice of three or more insurers, compared to 85% of enrollees (living in about 63% of counties) in 2016.
  • Rural areas have fewer insurers than metro areas. In 2017, metro areas have 2.5 insurers vs. 2 insurers in rural areas. 87% of 2017 enrollees live in metro areas.
  • Many counties are served by one carrier, most likely a Blue Cross Blue Shield or Anthem plan. In 2017, about 21% of enrollees (living in 33% of counties) have access to just one insurer on the marketplace (up from 2% of enrollees living in 7% of counties in 2016).

How has the mix of insurers impacted your network? Has your network participation in the ACA changed over the last four years?

Tags: ACA, ACA. healthcare exchanges, health insurance, health insurance co-ops, Affordable Care Act, Healthcare

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

What Gets Measured Gets Managed - Net Change and Total Change

Posted by Susan Donegan on Fri, Apr 28, 2017

When you subtract the number of providers who leave the network from the number who've joined for a time period, you get an important metric, Net Change. Net Change measures the overall growth in a network. Potential clients are looking for long-term relationships, and while losing providers isn’t positive, the ability to replace them efficiently is a strength.  

net change.jpg

In the example above, while Network A lost 8% of its providers during the time period versus only 6% for Network B, it was able to more than replace them, with adds of 14%. Network A’s net growth of 6%, compared to the competitor’s growth of just 2%, can be positioned as a clear advantage. From a management perspective, Net Change also serves well as a key performance indicator for provider relations teams.

Another important metric is Total Change, which demonstrates the amount of movement in a network or a market. While Net Change measures network growth, Total Change simply measures movement. It shows the overall change in the makeup of the network over time. Using the previous example, Network A had a total change of 22% (14% adds plus 8% drops) versus Network B’s total change of 14% (8% adds plus 6% drops.)

total change.jpg

Employed by itself, Total Change is not all that revealing. However, when combined with Net Change, it creates a powerful new metric for gauging the productivity of your network development activities compared to internal benchmarks and relative to your competition, which we call the Network Productivity Index.   

Download our whitepaper to better understand the dynamics of provider networks and measuring all of the productivity index components - adds, drops, net change and total change.

Tags: network productivity, network growth, health insurance, healthcare providers, compare networks

 

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