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The NetMinder Blog

What Gets Measured Gets Managed - Adds and Drops

Posted by Susan Donegan on Thu, Apr 05, 2018

“Adds” are providers that are new to your network – or your competitor’s. Adding new providers to your network means more choice for current clients and less disruption for potential new clients and enrollees. Measuring the number of new providers added to your network, segmenting the new participants by specialty, and sharing reports with clients and prospects regularly can be useful sales tactics.

Adds_Drops

But comparing your adds to those of competitors can be even more valuable. If you’ve added more in total, or more in a particular specialty, the sales team can use this information to demonstrate growing competitive strength. And what if the competitor has added new providers you don’t have? There’s no better way to identify targets for recruitment. 

“Drops” are providers who have left the network. Turnover is an important metric, and is often included as a performance guarantee in RFPs for new business. “After adjustment for plan characteristics, health plans with higher primary care provider turnover rates had significantly lower measures of member satisfaction,” according to a study published in the American Journal of Managed Care.

It is important – and relatively easy – to measure your own turnover rate. This is an indicator executives often use in setting performance targets for provider relations teams. You should be able to drill down geographically, and by specialty. But what if a sales professional could say to a prospective client: “Our turnover rate for primary care physicians is the lowest in the state – 12.5% better than the closest competitor. If you’ve dealt with employees lately who’ve experienced disruption, you know how important that can be!” Specific, accurate comparisons are much more compelling than phrases like “low turnover.” 

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: healthcare providers, network disruption, network comparisons, network metrics, network analysis, network strength, network comparison tool

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

Healthcare Mergers On the Rise in 2018

Posted by Laura McMullen on Thu, Feb 22, 2018

A trend that got a lot of attention at the end of 2017 was insurers moving further into healthcare delivery. These three high-profile transactions are just the latest examples:

  • Humana purchased 40% of Kindred Healthcare, a group of long-term acute care and inpatient rehabilitation hospitals.
  • United Health Group purchased DaVita Medical Group, nearly 300 clinics and six outpatient clinics in Florida, California, Colorado, Nevada, New Mexico, and Washington, from DaVita Inc., one of the largest kidney care companies in the U.S.
  • CVS is buying Aetna, combining CVS’ retail presence, pharmacy solutions, infusion services, and nursing professionals providing in-clinic and home-based care across the nation with Aetna’s national, regional, and state insurance offerings.

mergers and acquisitions.jpgIn Pennsylvania, the line between providers and insurers has been blurred for a long time. Highmark Health and the University of Pittsburgh Medical Center are realigning their networks as they compete for market share in central Pennsylvania. Most UPMC hospitals are leaving the Highmark network in June 2019. Highmark’s Allegheny Health Network announced a partnership with Penn State Health in December 2017 and a joint venture with Geisinger in May 2017. UPMC formed a joint venture with Reading Health System in late 2016 to offer health insurance in southeastern Pennsylvania and completed a merger with PinnacleHealth in September 2017. Additionally, both systems are investing in specific service lines in Pittsburgh. This Modern Healthcare article details the rivalry between the two companies.

And more mergers appear to be on the way in 2018. The results of a Capital One Healthcare survey in Modern Healthcare found that about half of the respondents in its middle-market sample plan to buy or merge with existing businesses this year. In addition, 20% said they plan to revitalize and update existing offerings while 21% said they plan to launch new segments or sectors. The primary reasons cited for these actions are pricing pressure, availability of private equity, and filling in service gaps. The uncertainty around the Affordable Care Act is inhibiting the desire to add new businesses somewhat, particularly in segments dominated by government-sponsored insurance.  

How are provider mergers affecting your network? What about provider-insurer combinations?

Tags: healthcare mergers, healthcare networks, healthcare providers, healthcare insurers, health insurance mergers, insurance networks, healthcare system

How Does the Narrow Network Trend Play Out in Behavioral Health Networks?

Posted by Laura McMullen on Thu, Jan 11, 2018

A recent article from Kaiser Health News discussed a study from researchers at the University of Pennsylvania about narrow behavioral health networks. The researchers compared mental health provider participation in marketplace networks to primary care physician participation in the same networks using 2016 data from the Robert Wood Johnson Foundation for 531 provider networks offered by 281 insurance carriers in the marketplaces in every state plus the District of Columbia. 

Here’s what they found:mental healthcare.jpg

  • The average provider network includes 11% of all the mental health care providers in a given market while 24% of PCPs participate.
  • An average marketplace plan’s network includes just under 25% of all psychiatrists and 10% of all non-physician mental health care providers. Non-physician mental health care providers included psychologists, nurse practitioners and physician assistants, and behavioral specialists, counselors and therapists with master’s or doctoral degrees.

How do these counts compare to commercial behavioral networks? We looked at unique provider counts in the 5 largest behavioral health networks in NetMinder and here’s what we learned:

  • Total mental health care provider participation ranges from 18% - 27%. Total PCP participation ranges from 27% - 41% in medical networks from the same companies.
  • Commercial networks include 12% - 34% of psychiatrists and 16% - 42% of psychologists who participate in at least one network.

While more behavioral health providers participate in commercial networks, the trend is similar. The study went on to consider reasons for the gap:

  • Low levels of network participation among mental health care providers. Among physician specialties, psychiatrists are least likely to join networks, according to a 2014 study in JAMA Psychiatry. While this research was limited to psychiatrists, other private-practice mental health providers have similar participation levels.
  • Reimbursements drive behavior. Many plans don’t reimburse providers for case management and other non-physician services. Psychiatrists prescribe medication which is reimbursed at a higher rate than therapy and often covered in medical plans leading them to participate in those networks instead of behavioral health networks.
  • Shortage of mental health providers. While psychology is consistently one of the top 10 college majors, there is a shortage of psychiatrists and psychologists, as we noted in a 2016 post. In 2017, psychiatrists are ranked #17 and psychologists are ranked #30 in US News and World Reports list of 100 Best Jobs based on demand, salary, job satisfaction, and other factors.

The decade-long push for mental health parity in insurance coverage has provided incentives to fill this gap. Primary care physicians, physician assistants, and other non-physicians are providing mental health services. In fact, NPR and Kaiser Health News reported that a recent Milliman study found that “insurers paid primary care providers 20 percent more for the same types of care than they paid addiction and mental health care specialists, including psychiatrists.”

How is your network adapting to the changing market?

Tags: behavioral health, mental health care, narrow networks, behavioral health networks, healthcare providers, healthcare benefits

Four Ways to Improve Your Provider Directory’s Accuracy

Posted by Laura McMullen on Fri, Dec 15, 2017

Initiatives to Improve accuracy in provider directories are gathering steam in companies that offer Medicare Advantage plans. Because the federal government pays for these plans, it’s no surprise that regulations and the vendor approval process are driving the improvements. CMS audits online directories and if inaccurate data is found, it can affect the plan’s star ratings. Regulations allow for civil monetary penalties, notices of noncompliance, and warning letters for deficiencies – which affects Past Performance Analysis results that could lead to denied applications.

provider data.jpgThere’s also a promotional impact. Star ratings are used by beneficiaries to choose between Medicare Advantage plans, so a drop there could discourage enrollment in favor of a plan with a higher rating. And the enrollee “grapevine” is sure to spread the word about how difficult it is to make appointments because the provider directory is inaccurate which can also affect enrollments.

Perhaps more important than the downside of inaccurate data is the upside of better business results. “Plans need accurate, complete provider data to run their business, especially with value-based care arrangements and things like that,” Lucia Giudice, Deloitte Consulting’s managing director and government programs practice leader told AIS Health for an October article in Medicare Advantage News (registration required). For ACOs and other organizations better data translates directly into better revenues.

AIS Health/Medicare Advantage News interviewed Kenneth Wrzos, senior director for operational excellence at EmblemHealth, about their provider directory information. Here are some tactics they find useful that can be applied to any provider directory for any line of business or type of plan:

  • Use a “front-end validation team” to assess the quality of provider data from delegated entities before adding it to the network. This team calls a sample of providers and then a network management team works with the providers to correct any inaccurate data.
  • Audit internal directory data periodically. This proved so helpful EmblemHealth increased the frequency from quarterly to monthly.
  • Analyze claims data to target records for cleaning. Locations that haven’t been paid at least one claim in 12 months get special attention. This has proven helpful in reducing dental directory inflation.
  • Reconcile rosters with large groups regularly. Staff at large group practices change frequently which can have a big impact on your network. Getting ahead of these changes by periodically comparing the provider’s office roster to your provider directory makes things easier for everyone.

Clean provider information in your directory is a competitive advantage. What are you doing to make it easier for current and prospective members to find what they are looking for?

Tags: provider directories, medicare advantage, healthcare providers, healthcare networks

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

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

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

Healthcare Jobs Continue To Be The Best Jobs

Posted by Laura McMullen on Thu, Apr 13, 2017

The 2017 U.S. News & World Report rankings of the best jobs in the US are out and 8 of the top 10 are healthcare providers. Dentists are back on top after slipping to second after orthodontists in 2016; anesthesiologists and psychiatrists fell out of the top 10. Nurse practitioners moved up the most spots (from sixth to second) and orthodontists moved down the most (from first to fifth).  

Here’s the Top 10:  

best jobs_table.jpg(Statistician was fourth and computer systems analyst ranked eighth to round out the Top 10. Click here for the whole list.)

Healthcare jobs have dominated the top 10 for the last few years with solid demand, high job satisfaction, and strong salaries. Like last year, dentists, nurse practitioners, and physician assistants make up the clear majority of the projected demand. All three are generalists who offer treatment to people of a variety of ages on a routine basis. The rest of the providers in the list are specialists who provide care for people with specific needs.  

NetMinder Shows More Specialists Are Joining Networks

Generalists are in higher demand with more open positions overall. Interestingly, NetMinder shows that generalists are being added to provider networks more slowly than specialists.  

  • The number of general dentists who participate in national provider networks grew 11% between March 2016 and March 2017 while dental specialists grew 24% in the same period. 
  • The number of primary care physicians in broad, national networks grew 11% during the same period while specialists grew 15%.  

Two possible reasons for this are (1) specialty care costs more so carriers are motivated to add specialists to their networks and (2) there are more specialists than generalists. Medical networks are more mature than dental networks, which explains the slower growth rate of medical specialists in networks. 

The overall demand reflects the increased need for healthcare services in the US. Factors contributing to this need are: 

  • The aging of the US population. By the year 2040, about 22% of the population will be over age 65, per the US Administration on Aging. And we’re living longer: the Census Bureau reports that the average time to live for those turning 85 increased from 5.5 years in 1972 to 6.5 years in 2010. 
  • The shortage of doctors and nurses. Rigorous, lengthy, and expensive training requirements and the aging of the workforce plus unsatisfactory working conditions make these professions less attractive to young people. Some shortages result from faulty geographic and specialty distribution of healthcare professionals.  

While the greater demand for generalists is in line with the triple aim of the Institute for Healthcare Improvement: improve the patient experience (including quality and satisfaction), improve the health of populations, and reduce the per capita cost of health care, the shortage of specialists is also being felt. 

Demand For Specialized Healthcare Providers Small But Significant 

As we’ve seen in other years, the absolute number of professionals needed in these specialty fields is low, i.e. orthodontists, oral surgeons, and nurse anesthetists. Yet, the demand represents a significant percentage of the workforce and the training programs are long and rigorous requiring long lead times to fill openings. Many of these professionals serve limited populations during occasional periods with time-consuming or high-risk services which also suppresses demand resulting in a few openings with high rewards.  

All eight have similar satisfaction rankings and unemployment rates with the major differences in demand and salary possibilities. 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 methodology here

How are you addressing these supply and demand trends in your network development plans? 

Tags: best jobs, healthcare providers, healthcare jobs, dentists, Medical, medical specialties, network development

Extending Your Reach with Telehealth Services

Posted by Laura McMullen on Mon, Dec 12, 2016

Medicare seems to be proceeding cautiously with telemedicine. Traditional Medicare reimburses healthcare providers for 37 services in specific circumstances when they are delivered using telemedicine, which is defined by the Medicare Learning Network as “an interactive audio and video telecommunications system that permits real-time communication between you … and the beneficiary.” These services range from consultations to education and training sessions to psychotherapy and smoking cessation programs.

Employer groups, on the other hand, are embracing telehealth benefits. Typical telehealth services are accessible 24/7 via smart phone, tablet, computer, or telephone. A recent article in CFO Magazine discusses the results of the latest Mercer National Survey of Employer-Sponsored Health Plans. Here are the highlights:

  • Nearly 60% of employers offered telehealth benefits in 2016. Nearly four times as many as (16%) offered them in 2014 and double the percentage (30%) that offered them in 2015.
  • Three-quarters of employers that offer telehealth share in the cost of each visit by offering plans with visit copays of $25 vs. the retail cost of a telehealth visit of $40.
  • More than one-quarter (28%) of large employers that offer telehealth also offer cost transparency tools to help employees make cost-effective choices.

This strong interest in telehealth is another method to help employees better manage their healthcare costs. As more and more workers (29% in 2016 vs. 25% in 2015) have high-deductible health plans, they are looking for lower-cost alternatives to access care.

cost of care.jpg

Source: Smart Business News, Debt.org

Retail Clinics and Telehealth Services Stretch Networks

Narrow networks are more common each year. Members report longer appointment wait times in HMO networks and other networks that have gatekeepers. And in open access narrow networks there are fewer available providers requiring many members to change doctors when they first join the plan and change again as doctors move in and out of the networks.

Employee Benefit News (registration required) noted that “82% of respondents [to the Mercer survey] cover visits to a retail clinic as another lower-cost and convenient option for their health plan members. Such a visit typically costs about $60 before the annual deductible is met.” With lower costs and convenient hours, many people find that these clinics, like telehealth services, are a good option to supplement plans with narrow networks.

Telehealth services also enable faster communication with a primary care doctor, shorter wait times, and no travel time when compared to an ER or urgent care center visit.

Has telehealth become a viable substitute for in-office care for your members? How are you using telehealth services to expand your network?

Tags: telehealth services, narrow networks, HMO networks, healthcare benefits, healthcare providers

 

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