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

Voluntary Ancillary Growth is a By-Product of ACA

Posted by Laura McMullen on Fri, Jun 24, 2016

Business is booming for insurance companies specializing in ancillary benefits for employer groups – and the mandated benefit requirements of the Affordable Care Act are driving the growth. A 2016 study of Form 5500 Schedule A data by analytics firm, miEdge, valued the market at more than $1 billion in 2015, a gain of 3.32% over the previous year.

Employee Benefit Advisor interviewed four ancillary companies with double-digit growth to learn more about their strategies to capitalize on this trend. Click here to read the article. Here are some highlights:

  1. Medical premiums are still growing in part due to mandated benefit provisions in the Affordable Care Act. Brokers and employers are looking for ways to offer comprehensive benefits without raising overall cost and voluntary ancillary options fit right in.
  2. Private exchanges make it easier to offer a mix of voluntary and employer-paid benefits from multiple carriers. Employees are comfortable with e-commerce so online enrollment is business-as-usual.
  3. Pediatric dental care is required by the ACA creating a new market for dental benefits. More interest and education about dental has opened the door to other ancillaries, such as vision (often sold with dental) and even legal plans.

Employee Benefit Advisor reported “the top five grossers in voluntary benefits, according to miEdge, were Delta Dental of Rhode Island (up 105.59% and over $40 million), Delta Dental of Illinois (up 99.34% and over $46 million), Combined Insurance Company of America (up 82.03% and over $81 million), Hyatt Legal Plans (up 21.12% and over $15 million), and Principal Financial Group (up 20.83% and over $14 million).”

How is your company capitalizing on this trend?

Tags: Affordable Care Act, Ancillary benefits, ACA, insurance companies, employee benefits, HIX

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

Discount networks benefit providers and consumers

Posted by Laura McMullen on Tue, Jul 21, 2015

dscount_plansDiscount plans offer pre-arranged discounts at participating providers and offices. These programs are not insurance. The Federal Trade Commission explains the difference between discount plans and health insurance this way:

  • If you buy a health insurance plan, it generally covers a broad range of services, and pays you or your health care provider for a portion of your medical bills.
  • With a medical discount plan, you generally pay a monthly fee to get discounts on specific services or products from a list of participating providers. Medical discount plans don’t pay your health care costs.

The Affordable Care Act changed the market for medical plans by requiring people to buy health insurance, although medical discount plans are still available. Dental and vision discount plans are widely available for purchase. Prescription discount plans are also available for those who qualify.

The companies that manage these plans have a variety of relationships with the providers in their networks. Here are some examples:

  • Insurance Carriers: Assurant, Careington, Aetna’s Vital Savings program. Insurance companies offer discount plans using their PPO networks as a way to generate more cash business for their providers and make popular non-covered services available to their members. LASIK and teeth whitening are examples of services that are often purchased using discount plans. Typically discount plans define eligible services by vertical industry, such as alternative medicine, dental, or vision.
  • Discount Program Organizations: AmeriPlan, Access to Healthcare Network, Patriot Health, dentalplans.com. Discount networks are purpose-built and sold in the open market. Providers like these plans because there is less paperwork, fewer rules, and payment is received when services are rendered. Members like them because they can choose any provider in the network, there are no deductibles or maximums, and there are no waiting periods. While these plans can’t be coordinated with Medicare or Medicaid, they can be used in conjunction with many commercial plans. These plans are usually organized by vertical.

Prescription Assistance Programs are included in the discount plan category, although they are a little different. They often have application processes that require approval from health care providers and are affected by income level and the cost of the medication needed. PPARx.org is a clearinghouse sponsored by the biopharmaceutical research companies that help connect qualifying patients with the program that’s best for them.

Do the providers in your network value discount plans as a way to diversify their income streams and attract new patients? How do your members feel about discount plans as a supplement to their insurance plans?

Tags: health insurance, Affordable Care Act, ACA, provider networks, insurance companies, dental discount plans, discount health plans, medical discount plans, vision discount plans, health care provider

The impact of integrated health care delivery systems is growing

Posted by Laura McMullen on Thu, May 28, 2015

Hospitals have always had informal networks of nearby physicians with admitting privileges as well as staff physicians. And some hospitals and health systems, particularly those that self-insure, have long required employees to access care within their organization to help control costs. With a new set of incentives in the Affordable Care Act that encourage providers to focus on outcomes instead of activity, these practices came together to reduce the barriers to entry in the health insurance industry and create new entities that compete for premium dollars.

Cutting Out the Middlemen

hospitalLarge hospitals and local or regional health systems have formed insurance companies that sell plans to employer groups and individuals, i.e. North Shore – Long Island Jewish Hospital’s CareConnect or UPMC in western Pennsylvania. Dr. Kenneth L. Davis, CEO and president of Mount Sinai Health System in New York, said, “Inevitably the large systems are going to move to take part of the premium dollar,” in an article in the Fiscal Times after the 2014 Health Care Forum in Washington, DC, sponsored by The Atlantic. He went on to discuss the importance of “retaining more and more of the health care premiums paid by consumers is essential to providing a full spectrum of care.” For example, St. Luke’s Hospital, part of the Mount Sinai Health System, lost $14 million in its psychiatric program in 2013 and needs to be subsidized by revenue from other parts of the system. Offering insurance coverage is another way to do that.

Partnering to Compete

Some insurance companies own hospitals, other facilities, and physician groups which are included in their networks, for example Kaiser Permanente or Willamette Dental Group. Others choose to create new companies such as the joint venture between Anthem and seven Southern California hospitals when they formed Vivity Health Plan. Vivity is priced below Anthem’s standard HMO plan and includes the big academic medical centers consumers want access to, according to the LA Times. This new market entrant could take business away from Kaiser Permanente in the large Southern California market.

Too Big to Fail?

Another approach is for hospitals to merge. There were 95 hospital mergers and acquisitions in 2014, according to The ObamaCare Effect: Hospital Monopolies in the Wall Street Journal. Two acquisitions are being challenged in state court:

How does this trend play out in your network? Does hospital consolidation make it easier to set up a narrow network? Or is this an opportunity to add more locations and providers through the physician groups that are included in integrated health care delivery systems?

Tags: health insurance, narrow networks, Affordable Care Act, health reform, consumer choice, insurance companies

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 CO-OPs.co-ops

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

How does network leasing work in health insurance?

Posted by Laura McMullen on Thu, Mar 26, 2015

In a previous blog post, we explored the narrow network trend that began with HMOs and resurfaced on the federal and state exchanges from the Affordable Care Act. In that post we also touched on some of the new entrants into the health insurance market like co-ops and health system-based networks. This is the first of a series of posts that explores these new entrants and their network structures further.

healthinsuranceHistorically, insurance companies built and maintained their own provider networks. As the healthcare market changes, new network organizations have become more prevalent and visible and existing networks have been put to different uses. These network organizations can be categorized into six groups: network leasing companies; CO-OPs; TPAs and other cost management experts; discounters; hospitals and health systems; and accountable care organizations (ACOs).  Each of these categories has a slightly different perspective on managing provider relationships – some work closely with providers while others are at arm’s length – and it’s important to keep these differences in mind as you compare networks. This post takes a look at network leasing companies and future posts will examine the other types.

Network Leasing Companies

Many medical and dental networks use leasing partners to fill in service area gaps, meet network adequacy requirements, move into new markets, and grow their networks in general. There are two types of PPO networks that are available for lease.

Insurance companies take the financial risk for an enrollee’s medical costs and offer a network of providers who accept reduced fees for access to enrollees to control those costs. Staff at the insurance company recruit providers into the network and manage the ongoing relationships. When carriers have excess capacity in their networks, they sometimes decide to lease or swap all or part of the network to other companies. Lease arrangements earn additional revenue for insurance companies through monthly network access fees. Swaps fill in network gaps which can create a stronger sales advantage.

Examples of insurance company networks available for swap or lease:

Non-risk PPOs offer providers a fee schedule for covered services and then sell access to the network to other entities, i.e. insurance companies, employer groups, associations, unions, etc. The company offering the PPO doesn’t take the risk for the enrollee’s medical costs. The provider’s contract is with the network leasing company and the leasing entity is one step removed. The network leasing company receives a monthly network access fee for every person who can use the network, although other arrangements are possible. These arrangements are popular in medical and dental networks with standalone companies and carriers offering their networks for lease.

Examples of non-risk PPOs available for lease:

Vision networks are also leased as non-risk PPOs or offered under their own names by medical or dental carriers where the risk is taken by the vision plan. EyeMed and Block Vision are active in this space.

When leasing all or part of a network, it is important to make sure that all providers are properly contracted to offer discounts to members. When networks are “stacked,” offering multiple networks within a service area to achieve higher discounts, providers can be confused about which fee schedules are in effect. Confusion in the provider’s office can lead to member dissatisfaction if the wrong coinsurance or copay is charged which ultimately leads to lost business. When leasing, be sure your network team works closely with its counterparts in your lease partner’s organization.

How does network leasing fit into your business plan? Are you looking at new service areas? Do you have network adequacy requirements to meet?

Tags: network providers, Affordable Care Act, network leasing companies, dental PPO networks, insurance companies, vision networks, non-risk PPOs

Including employee census data in your network analyses

Posted by Laura McMullen on Thu, Jan 15, 2015

Employee censuses are the heart of the group insurance business. Sales and underwriting teams use them during the sales process, enrollment portal credentials are established using them, and billing and eligibility files are subsets of these lists. Another common use is network accessibility analyses to determine how many providers are within a standard distance.

To take accessibility analyses a little farther, consider including NetMinder reports in the underwriting process to see where you have network advantages and disadvantages for a specific employee population. When you are a finalist for a group, there’s usually only one or two other competitors to evaluate. For some cases though, it’s worth it to compare to a larger group of competitors early in the process to give your team the best possible chance of winning.

To make this analysis easier, we recently added the capability to run NetMinder reports using your client’s employee census to select the geographic area you want to analyze.

Upload your file using the UPLOAD CUSTOM CENSUS option in the geographic scope selection box and make the rest of your choices as usual to get started.

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Using custom census geographies has these benefits:

  • Your network comparison will include all of your client’s key areas and match up easily with other analyses.
  • All of the ZIP codes in the file will be included in your report – even if they are not all in the same state.
  • You can use custom census geographies with any NetMinder report – summary or detail. The report will return counts or details 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.

How do you match employee censuses with competitive network data?

Tags: market comparison, data analysis, insurance companies, network comparisons, ZIP codes and cities, Custom Geographies, NetMinder new features

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

UnitedHealthcare Plans to Expand Exchange Presence

Posted by Laura McMullen on Tue, Aug 12, 2014

UnitedHealthcare is betting that the health insurance exchanges are sustainable for the long-term, Kaiser Health News reported in July in a post titled Biggest Insurer Drops Caution, Embraces Obamacare.

What’s behind this decision?

  • understandingtheaca resized 600The marketplaces look viable, even without some of the government safeguards like risk-sharing and reinsurance support that will end after the first few years.
  • The pricing is clearer. With six months of claims experience from millions of people, UnitedHealthcare believes they can accurately rate their products.
  • The regulations are in place. Many of the pending lawsuits have been decided.
  • Consumer behavior is more certain. Even with all of the delays and challenges during the initial implementation of the federal exchange, millions of transactions have been completed and UnitedHealthcare believes “there’ll be some shopping, even though people don’t have to shop,” according to Jeff Alter, head of UnitedHealthcare’s employer and individual insurance division. “The natural consumer play of an exchange is going to cause a shopping experience.”

Does UnitedHealthcare’s entry change anything about your exchange strategy? Is this an attractive market for starting or expanding an insurance company?

Tags: health insurance, Affordable Care Act, healthcare reform, ACA, healthcare exchanges, consumer choice, Obamacare, insurance companies

 

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