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The NetMinder Blog

NetMinder's Data Brings Intelligence to Recruiting

Posted by Susan Donegan on Tue, Jun 27, 2017

NetMinder provides the data you need to recruit proactively. A shorter target list of the best prospects makes it easier to succeed, and less expensive to do so.

Here are just a few of the ways network managers can use real market intelligence to recruit proactively.

  • intelligent recruiting.jpgLearn which dentists participate in many networks. They'll be more receptive to adding new networks and can help you grow more efficiently.
  • Find locations with multiple dentists. This creates efficiency in increasing sheer numbers of dentists.
  • Find dentists who practice in more than one location. This makes it easier to increase listed locations, compared to recruiting one at a time.
  • Find dentists where you know they are practicing. Confirmed by submitted claims, practicing locations are your best place to find dentists to recruit.
  • Target dentists who are heavily utilized. Selecting those with more cliams activity helps you find the more popular dentists.
  • Look for dentists who accept discounts. Prospects who accept discounts from others should be more affordable.   

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

Tags: insurance companies, dental network, practicing locations, claims data, Healthcare, insurance networks

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

Measuring the Performance of the US Health System

Posted by Laura McMullen on Thu, Jun 01, 2017

Healthcare spending represented 17.8% of US GDP in 2015. What are we getting for our money? The Kaiser Family Foundation and Peterson Center on Healthcare are trying to find out.

US healthcare.jpgThe newly redesigned dashboard added to the US Health System Tracker makes it easier for people to find the latest quality, spending, access, and outcome metrics describing the US health system. According to the announcement, the dashboard shows an overview of the system’s performance compared to other similar countries as well as analysis of specific indicators measuring health and wellbeing, quality of care, health spending, and access and affordability.

The Tracker first launched in 2014 as a partnership between the Kaiser Family Foundation, a leader in health policy analysis and health journalism, and Peterson Center on Healthcare, a non-profit organization that searches for innovative solutions that increase quality and reduce cost in healthcare and accelerates adoption nationwide.

The latest brief based on the Tracker data is US health system is performing better, though still lagging behind other countries. Here are some findings that focus on the cost of healthcare:

  • The uninsured rate among nonelderly Americans dropped from 18% in 2010 to 10% in 2016.
  • The percentage of adults who reported being worried about medical bills dropped 10% between 2011 and 2016.
  • The percentage of Americans who put off or didn’t seek care due to cost dropped from 13% in 2009 to 9% in 2015.
  • Health spending per capita grew 3.6% annually from 2010 to 2015.

Does higher utilization in the short run lead to healthier populations and lower long-term spending?

Tags: Healthcare, US health system, uninsured, healthcare cost

Open Enrollment 2017 Opens This Week Amid Rate Hikes and Fewer Plan Options

Posted by Susan Donegan on Mon, Oct 31, 2016

Federal regulators opened the federal exchange Healthcare.gov for consumers to browse for plans on Monday, as they announced that rates will be up 25% for the plans for which the tax subsidies are calculated. HHS also warned that more than one in five consumers using the site will only have one insurer from which to choose coverage. The second lowest cost silver plan on the exchanges is the benchmark plan that regulators base tax credits on. That's the rate that is up 25%, which is also the expected overall increase in 2017. (USA Today, 10/24/16)

Health insurance companies are still struggling with improving price transparency in order to gain greater trust from their consumer base. One survey has shown low customer service satisfaction and a need for payers to inform consumers about their financial responsibility. Commercial health payers may lose contracts with employers by lacking price transparency. Adam Russo, CEO of Phia Group, explained that the lack of price transparency led him to self-insure his employees. (HealthPayer Intelligence, 10/24/16)

The White House predicts 13.8 million people will enroll in a health plan on the Affordable Care Act’s exchanges by Jan. 31, the end of the open enrollment for 2017 coverage. That marks a 9 percent increase beyond the 12.7 million plan selections by the end of open enrollment in 2016. (The Business Journals, 10/20/16)

Hundreds of millions of dollars have been invested in dozens of fledgling health insurance companies. More than $1.3 billion was invested in these companies in the United States in 2015 alone, according to CB Insights. With all the funds and fanfare surrounding health insurance startups, how do they plan to change the insurance industry? (Healthcare Dive, 10/19/16)

When the health insurance marketplace opens, many consumers will have a new option for fourth open-enrollment period: standardized health plans that cover basic services without a deductible. With many health plans on the marketplace including deductibles in the thousands of dollars, consumers have complained that they were getting little benefit beyond coverage for catastrophic problems. (The New York Times, 10/17/16)

"Clearly, there are many individuals who are not getting federal premium subsidies who could face significant increases in their costs next year. These increases are likely to be bigger than those that occurred in 2015 and 2016. However, prior to the ACA, annual premium increases were around 10% per year. So, the 2017 rate hikes will be more in line with historical trends," says Caroline Pearson, senior VP at Avalere Health LLC. (AIS's Inside Health Insurance Exchanges.. From INSIDE HEALTH INSURANCE EXCHANGES"Subsidies Insulate Many From Rate Hikes; Millions Aren't Eligible", 9/29/16)

Tags: ACA, HIX, Healthcare, healthcare exchanges

CMS Efforts to Ensure Network Adequacy and Alter Risk-Adjustment Payments

Posted by Susan Donegan on Fri, Sep 30, 2016

CMS is aware that some states may struggle more than others in developing strategies that ensure network adequacy, especially those with large rural populations. So, CMS is teaming up with Medicaid directors to create a guidance that will read more like a best-practices document, James Golden, director of the agency's division of managed-care plans, said at the Medicaid Health Plans of America conference. (Modern Healthcare, 9/22/16)

HHS’s proposed Notice of Benefit and Payment Parameters for 2018 could alter the way risk adjustment and other tenets of ACA exchanges work, but the provisions, to keep carriers on the exchanges or bring back those that have left, failed to impress Wall Street or ease concerns of insurers. One major analyst said the sheer complexity of the formulas used by HHS is one of the reasons few health plans make money on public marketplaces. (Health Business Daily, 9/20/16)

Urban Institute researchers found that, in more than three-quarters of states and 80 percent of the large metropolitan areas they studied, total premiums were lower in an average marketplace plan than in employer-provided plans. "It's not that these markets are necessarily outrageously expensive -- in the vast majority of cases they're not," said Linda Blumberg, a senior fellow in the health policy center of the Urban Institute. However, most people who receive health insurance through their employers directly pay only a portion of the premium each month. The rest is paid by the employer, as part of workers' compensation. (Washington Post, 9/19/16)

President Barack Obama urged U.S. insurers offering coverage next year on the exchanges to step up their efforts to enroll those who remain uninsured, especially younger and healthier Americans. His administration will help find and enroll those who still lack coverage, with a particular focus on enrolling young adults. (Fortune, 9/13/16)

Blues Plans Updates:

Blue Cross Blue Shield of Tennessee, the state’s largest health insurer, announced plans to exit the federal health exchanges in Nashville, Memphis and Knoxville next year. The insurer cited considerable losses and the ongoing uncertainties on the individual health marketplaces created under the Affordable Care Act (ACA) as reasons for the withdrawal. (Insurance Business America, 9/27/16)

Blue Cross Blue Shield of Nebraska (BCBSNE) plans to discontinue its ACA products due to poor financial performance threatening the payer’s responsibility “to remain stable and secure.” (Fierce Healthcare, 9/26/16)

Blue Cross Blue Shield of North Carolina (BCBSNC), has announced that it will continue offering ACA exchange plans. (Fierce Healthcare, 9/26/16)

Tags: HIX, ACA, Healthcare, health reform, healthcare exchanges

More Psychiatrists Needed

Posted by Laura McMullen on Fri, Jul 22, 2016

Mental health care is in the news almost daily these days. Common story lines are about undiagnosed people, rising substance abuse rates, and the high cost of care. A contributing factor is the shortage of highly trained providers. Psychiatrists ranked seventh in US News and World Reports 2016 Best Jobs list. Psychiatrists are a new entry in the list and represent 15% of the overall demand for the top 10 jobs through 2024. (Take a look at our blog post, Physician Assistants are in Demand, to see the other eight healthcare jobs that were in the top 10.)

More_Psychiatrists_Needed_image.jpgAccording to PsychCentral.com, “psychiatrists make up approximately 5 percent of all 661,400 physicians and surgeons employed in the U.S. in 2008. This is a rate similar to general surgery, OBGYN and anesthesiology.” In 2011, the Bureau of Labor Statistics estimated there were about 34,000 psychiatrists in the US. The demand for psychiatrists (4,200) represents ~12% of the current industry.  

Like with physician assistants and nurse practitioners, we’re seeing evidence of market demand in provider directories. We used NetMinder to analyze psychiatrist and psychologist populations in six large national behavioral networks and five large national medical networks between March 2015 and March 2016. Here’s what we found:  

    • Significantly fewer psychiatrists and psychologists participate in medical networks than behavioral networks. This reflects the common practice of carving behavioral health out of medical plans. 
    • Psychiatrists are in demand. Behavioral networks added twice as many psychiatrists as psychologists. Medical networks grew more slowly, adding just 5% more psychiatrists than psychologists. The shortage is felt in commercial networks as well as in other care settings. 
  • Each type of network focused on retaining different providers. Behavioral networks retained more psychologists. Medical networks retained more psychiatrists. Psychiatrists can prescribe medication so they fit better in medical plans with pharmacy benefits. And medication management is more lucrative. On average, a psychiatrist who charges for 45-50 minutes of psychotherapy earns $74-$107 less than he or she would for three 15-minute sessions of medication management. The reason may be that insurers figure that psychotherapy, which is time consuming and may go on for months, should be handled by providers who charge less. 

Similar to other jobs on the list that require long and rigorous training, psychiatrists report high compensation, strong job satisfaction, and low unemployment rates. As in past years, the rankings take compensation, flexibility, opportunities for advancement, market demand, amount of stress, and skills or training required into consideration. See the survey methodology here. 

How is the need for more psychiatrists affecting your network? 

Tags: Healthcare, medical networks, network data, best jobs, Health plan

Dental Care and America Have Come a Long Way – Happy 4th of July!

Posted by Laura McMullen on Fri, Jul 01, 2016

methyl_dental.png

Tags: Healthcare, dental

What Does Healthcare Really Cost?

Posted by Laura McMullen on Fri, Jun 10, 2016

The Affordable Care Act primarily addressed the cost and availability of health insurance. What about the cost of healthcare? An Unprecedented Look at Medical Costs Nationwide talks about The Health Care Pricing Project, which is looking at exactly that.

Researchers from Yale University, Carnegie Mellon University, and the London School of Economics examined $682 billion of healthcare bills for 88 million people from Aetna, Humana, and UnitedHealth. The study was funded by The Commonwealth Fund, National Institute for Health Care Management Foundation, and Economic and Social Research Council.

Here are some highlights from their first paper, The Price Ain’t Right? Hospital Prices and Health Spending on the Privately Insured:

  • “If you happen to live in an area with only one hospital you are going to pay more.”
  • “After decades of mergers, nearly a third of US markets have monopolies, or are close to having monopolies.”
  • Variation in provider price drives spending differences across Hospital Referral Regions for employer-sponsored insurance. Variation in quantity of care provided drives spending differences in Medicare.
  • Prices vary widely across the nation and significantly even within Hospital Referral Regions.

How does the variation in prices of health care services and it's influence on spending levels across the nation impact your organization?

 

Tags: health insurance, Healthcare, ACA, insurance companies, medicare, medical insurance

Guest Blog: The Affordable Care Act Part 2 – What’s Ahead for Small Businesses?

Posted by Louis Balbirer on Wed, Sep 24, 2014

Louis BalbirerLouis Balbirer of Kaufman Rossin writes a guest blog post for NetMinder about changes related to healthcare reform. This is the second post in a two-part series discussing opportunities and challenges of the Affordable Care Act. The first part of this series focused on large businesses.

In the four years since the passage of the Affordable Care Act (ACA), there have been a number of changes that can make it difficult for small businesses to interpret their responsibilities under the law. 

At the latest C-Suite Breakfast Series, co-sponsored by Kaufman Rossin and Vistage, a panel of experts discussed changes for small and large businesses brought on by the Affordable Care Act. Specifically, panelists told us what’s better, what’s worse and what’s ahead for small business owners.

Panelists included:

What are some opportunities for small businesses?

Small businesses, defined under the healthcare law as having 50 or fewer full-time equivalent employees, are exempt from many ACA requirements. The Affordable Care Act presents many small business owners and their employees with opportunities for tax credits, lower insurance rates and more extensive coverage.

The following are some of the ways the ACA could benefit smaller businesses:

  • The Federal Small Business Health Options Program (SHOP) marketplace allows small business owners to control the coverage they offer to employees and the premiums they pay for coverage.
  • According to the panelists, the quality of insurance coverage and healthcare are expected to increase because the Affordable Care Act mandates a broadened scope of coverage for certain conditions that were previously uninsured.
  • The lack of penalties for dropping insurance and the availability of the Exchange for employees make it easier for small employers to save by choosing not to offer health insurance for their employees.
  • Additional delivery systems allow employers to choose how they offer insurance to their employees. SHOP, the Marketplace and private exchanges allow employers to veer from the traditional model (or continue with it) when selecting health insurance options for their business.
  • Small businesses with 25 or fewer full-time equivalent employees are eligible for a maximum 50% tax credit if they pay premiums on behalf of their employees enrolled in a qualified healthcare plan through SHOP.

What has the Affordable Care Act made more challenging for small business?

Although they are exempt from parts of the healthcare law, small businesses still face some challenges as a result of the ACA.

The following have been made more challenging since the passage of the Affordable Care Act:

  • Employers must participate by buying and paying SHOP fees even if only one employee participates in an insurance plan.
  • Some small business owners will need more resources (including more employees) to properly comply with the tracking and reporting requirements under the ACA.
  • Some employers are discouraged from hiring because they do not want to have to comply with the pay or play mandate required of businesses with more than 50 full-time equivalent employees. Employees who work 30 or more hours per week are considered full-time under the ACA.

What’s ahead for small business owners?              

Small business owners should prepare to comply with the upcoming reporting requirements under the healthcare law and consult their broker and accountant with any questions, including how ACA-related tax changes may affect their tax bill.

I spoke with Joy Batteen, director of human resources at Kaufman Rossin and a panelist at the C-Suite Breakfast Series, about important next steps for small business owners.

“If a small business is considering hiring a broker, but is concerned about the cost, now is the right time to make that move,” said Batteen. “Hiring a knowledgeable broker – someone you can trust – makes dealing with ACA changes much easier. The law will affect different employers in different ways; the most important thing businesses can do is be prepared.”

Louis Balbirer, CPA, is a director of tax services with Kaufman Rossin, one of the top CPA firms in the U.S He has 20 years of experience providing tax and accounting services to clients and can be reached at lbalbirer@kaufmanrossin.com.

 

Tags: NetMinder, health insurance, Affordable Care Act, Healthcare, healthcare reform, health reform, healthcare benefits, ACA, healthcare exchanges, insurance companies

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

 

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