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The NetMinder Blog

The Fine Line Between Differentiation and Disruption

Posted by Laura McMullen on Thu, Nov 16, 2017

Switching networks can be rough, as the Texas Employees Retirement System found out when they switched to a Blue Cross Blue Shield of Texas HMO plan after using United Healthcare for several years. The Texas Blues plan uses the HealthSelect network which was designed for large groups offering ample coverage in Dallas, Houston, and other big cities. In rural areas, the Blue Advantage network, designed for small groups and individual plans, would have been a better fit, according to local experts. Blue Cross Blue Shield of Texas has moved quickly to address the network gaps. Members who are more than 30 miles from an in-network PCP or more than 75 miles from an in-network specialist can request network gap exceptions. Click here to read the Health Business Daily story that has more details from November 6, 2017. (registration required)

This type of situation happens all the time in the employee benefits industry. A network looks like it matches a group’s locations but when members start making appointments there are gaps. Minimizing network disruption to avoid employee dissatisfaction is often a big factor in making changes to the overall benefits package. Estimating disruption is one of the most common uses of NetMinder.

disruption.jpgCarriers have taken different approaches to managing the inevitable disruption that comes with changing benefit plans and networks.

  • Dental benefits companies frequently “stack” multiple lease partners on top of their direct contract network. Since many lease partners are working with multiple carriers, these networks are very similar which reduces disruption.
  • Vision benefits companies are starting to work with multiple lease partners which reduces disruption when moving between networks as well. Additionally, vision networks rely heavily on retail chains such as Target, Wal-Mart, and JCPenney which also reduces disruption.

Broad medical networks are alike due to the nature of employer-sponsored medical insurance: very few people decline it when offered and virtually all doctors accept insurance because costs are high and utilization is virtually guaranteed over a lifetime. Narrow networks, however, have introduced a new element of disruption into the medical network marketplace. As they continue to evolve, it will be interesting to see what tools and strategies are developed to minimize disruption and dissatisfaction caused by changing plans and doctors while keeping costs down.

How are your networks different from your competition? How do you measure and track the differences?

Tags: medical networks, disruption reporting, network disruption, employee benefits, dental benefits, Vision insurance, healthcare benefits

Which Specialties Are Most Important to Your Network?

Posted by Laura McMullen on Wed, Nov 30, 2016

The Pareto Principle says that, for many events, 80% of the effects can be attributed to 20% of the causes. This is true about the cost of healthcare both from the demand side where most of the need for services is in the last years of life and from the sickest part of the population and from the supply side where most of the physician expense is concentrated among several specialties. (Inpatient treatment and specialty drugs are large components of medical spend too but since NetMinder is all about networks, we’re going to concentrate our analysis on physician specialties.)

We analyzed five national commercial medical networks using NetMinder. The 10 specialties that make up the bulk of these networks are counseling, family practice, general practice, internal medicine, nurse, ob-gyn, optometry, physician assistant, pediatrics, and social work. They represent 55-67% of each network. It’s no surprise that primary care physicians make up the bulk of these networks – everyone needs one, even when there’s no gatekeeper, because consumers generally don’t know exactly what’s wrong when they go to the doctor. Another reason for this might be that competition for patients in some markets is fierce leading some types of providers such as optometrists, counselors, and social workers to look for ways to market their practices.

However, these specialties are not among the top-earning specialties.

In 2014, the New York Times reported the top-earning medical specialties are orthopedics, cardiology, anesthesiology, radiology, dermatology, plastic surgery, urology, gastroenterology and ophthalmology. The article goes on to say “Physicians in those fields typically earn more than $350,000 annually, according to American Medical Group Association, a trade organization. In many specialties, income has risen more than 10 percent since 2011, according to Medscape, a Web company that follows the industry.” The top-earner specialties make up 12-21% of the commercial medical networks we analyzed.

Two of them – internal medicine and family practice – are in the top 5 for Medicare cost.

In 2012, Bloomberg analyzed Medicare payments to individual providers by specialty. This list represents 60% of expenditures, and 34-62% of the commercial medical networks we analyzed.

specialty chart.jpgSource: Centers for Medicare and Medicaid Services, Bloomberg

Without network constraints and as the largest insurer, it stands to reason that the specialty types Medicare pays the most will be similar to the specialty types that earn the most. Five specialties – orthopedics, cardiology, radiology, dermatology, and ophthalmology – are in both lists. These five specialties represent 10-15% of the commercial medical networks we analyzed.

Take a look at our whitepaper, All Provider Networks are not Created Equal, for more about how to take the composition of a network into account when you are comparing networks.

Networks are built to meet the needs of the members who use them so we’d expect variation in the types of specialties that make up the bulk of each one. Do you have enough of the right type of providers in your network to support the demand? Which specialties are over-represented? Which are under-represented?

Tags: health insurance, medical networks, provider networks, medical specialties

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

 

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