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Synergies Helping the Dental and Vision Insurance Markets Work Together

Posted by Susan Donegan on Fri, Jan 26, 2018

In dental and vision insurance, the network is where the consumer experience happens. That’s why it’s important to know the network landscape and leverage all points of differentiation and separation from the competition.

First, a few definitions. These observations are based on a review of NetMinder data for the top 15 national dental PPO networks and the top 10 vision networks as of March 2015. A network is defined as a payer/plan combination, i.e. Delta Dental PPO or EyeMed Access. Counting methods are:  

  • Access Points: each provider at each location in a provider directory.  
  • Unique Providers: each provider one time regardless of the number of locations s/he is listed at in a provider directory.
  • Locations: each location one time regardless of the number of providers who are listed there in a provider directory.

AvgNetworkSize.jpgRelatively speaking, dental networks are much larger than vision networks. The supply of dentists is larger than the supply of optometrists and ophthalmologists. There are 65 dental schools vs. 23 optometry schools23 and nine dental specialties vs. two optometric specialties.

There is also greater demand for dental services:

demand_dental_vision.jpg

Download our whitepaper to learn more about these favorable trends as well as the synergies that help the dental and vision insurance markets work together. 


23 https://en.wikipedia.org/wiki/List_of_dental_schools_in_the_United_States:
24https://www.quora.com/How-long-does-a-routine-dental-checkup-normally-take-in-the-U-S-if-the-patient-is-perfectlyhealthy-and-schedules-one-every-six-months
25http://www.webmd.com/eye-health/what-to-expect-checkup-eye-exam-adults#1
26 http://health.costhelper.com/teeth-cleaning.html
27 http://eyeexamcosts.com/understanding-eye-doctor-costs/

Tags: dental insurance, Vision insurance, vision networks, dental network, access points, unique providers, provider locations, practicing locations, NetMinder, network analysis, network comparison tool

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

Changing Supply and Demand for Eye Doctors

Posted by Laura McMullen on Thu, Sep 11, 2014

Recently, the American Optometric Association and the Association of Schools and Colleges of Optometry, along with a number of vision industry leaders, commissioned the Lewin Group to conduct a study of the eye care workforce and create a computer model to continuously study supply and demand for eye care providers. AOA and ASCO leaders called the study “the most ambitious, comprehensive and forward-looking study of eye care supply and demand ever undertaken” in the release announcing the study. To get the National Eye Care Workforce Study go to aoa.org/marketplace (registration and fee required).

The study reports the same three factors that are driving demand for overall healthcare services are affecting the demand for vision care services:

  • The U.S. population is aging and its vision is deteriorating.
  • Diabetes is more prevalent than ever.
  • The ACA expanded the health insurance market and required vision coverage for children.

eye drThe National Eye Care Workforce Study reports an oversupply of optometrists and ophthalmologists through 2025. However, other experts frame a shortage.

One interpretation of the current market shows the supply of eye doctors is growing to meet the increased demand:

  • The supply of eye doctors is increasing. Three new optometry schools graduated their first classes in 2013 and another one will open in Kentucky in 2016. Every year 1,350 new optometrists graduate while 420 retire, according to a presentation Richard Edlow, OD, gave at the Integrated Ophthalmic Managed Eyecare Delivery program in April 2013. Some eye doctors postponed retirement until the U.S. economy rebounded, so the retirement rate will increase as the recovery continues.
  • Eye doctors could see more patients and keep their current schedules. Optometrists surveyed by the Lewin Group as part of the study reported that they could increase patient capacity by 32%, or 933 visits, annually without adding hours or days to their schedules.

Another interpretation shows that supply shortages are on the way while demand is growing:

  • More women are becoming eye doctors. “Fifty percent of ophthalmology residents are female, and 64% of optometry graduates are female,” Dr. Edlow said in his presentation. “Every study indicates that women work about 85% of a full-time employee. If we take this into account, we have 51,000 eye doctors, and we’re going to need 65,000.”
  • Eye doctors are working fewer hours. Most work 40 hours weekly as opposed to 50-60 hours weekly in the past.

The National Eye Care Workforce Study provides a snapshot of the current situation overview and also created a computer model to evaluate the workforce at future points in time. As time goes on and other factors come into play, the supply and demand picture will ebb and flow.

According to NetMinder, the industry standard for vision provider network comparisons, managed vision networks continue to grow, indicating strong demand from consumers and employers for access to vision care.

What do you see in your business?

Tags: NetMinder, vision market, Vision insurance, ACA, consumer choice, network comparisons, vision networks

Guest Blog: The Affordable Care Act Part 1 – What’s Ahead for Large Businesses?

Posted by Louis Balbirer on Fri, Aug 29, 2014

Louis BalbirerLouis Balbirer of Kaufman Rossin writes a guest blog post for NetMinder about changes related to healthcare reform. This is the first post in a two-part series discussing opportunities and challenges of the Affordable Care Act for small and large businesses. Material shared here was presented at the C-Suite Breakfast Series event, co-sponsored by Kaufman Rossin and Vistage.

By January 1, 2015, large businesses will need to decide if they are going to extend coverage to their employees or pay the annual fee for declining to “play.” For businesses, understanding their obligations under the Affordable Care Act (ACA) now and in the coming months is more important than ever.

The ACA was the topic of the most recent C-Suite Breakfast Series. A panel of experts discussed the impact of the Affordable Care Act on small and large business.

Panelists included:

What are some opportunities for large businesses?

Companies with more than 50 full-time equivalent employees are considered large businesses under the healthcare law. Large businesses are subject to many rules under the ACA that do not apply to small businesses.

The Affordable Care Act presents several opportunities for large businesses related to the insurance coverage options they provide to their employees.

  • The opening of the Small Business Health Options Program (SHOP) marketplace to businesses with 50-100 full-time employees in 2015 will offer employers additional insurance plan options.
  • According to the panel discussion, quality of insurance coverage and healthcare is expected to increase for employees at large businesses.
  • The delay of the Employer Shared Responsibilities Provisions until January 1, 2015, for businesses with more than 100 full time equivalent employees, allows employers more time to strategically position themselves to provide insurance in order to avoid associated penalties. Qualifying businesses with 50-100 full time equivalent employees have until January 1, 2016, to comply with the provisions.
  • Businesses that choose to participate in health insurance plans can use benefits as a recruiting tool to potentially attract higher-quality candidates than those who choose to pay the fees associated with not providing coverage.

What has the Affordable Care Act made more challenging for large businesses?

Large businesses have a greater responsibility than small businesses under the Affordable Care Act. A number of deadline changes have made the roll-out of the healthcare law even more confusing for large employers. Added expenses, additional reporting and mandatory coverage for all full-time employees are further complicating the process for large employers.

The following challenges face large businesses under the healthcare law:

  • Reporting responsibilities for large businesses mean added infrastructure is needed. In 2015, large businesses must start reporting on whether insurance was provided to employees, what type of coverage was offered, and some companies may be required to report on the value of the insurance provided to each employee on his or her W-2.
  • Guidance and regulations continue to evolve, making it challenging to plan and comply with the law.
  • Cost of insurance has increased (in most cases) due to plan design limitations and fees or taxes imposed by the Affordable Care Act.
  • Insurance rates may increase for employers if plan participation is low.
  • Employees may not be able to keep their current insurance plans due to ACA mandates.
  • Large companies that do not offer affordable coverage may be subject to penalties of up to $3,000 per subsidized employee.

What’s ahead for business owners?

Large businesses need to decide if they are going to pay or play by the January 1, 2015, deadline.

“When we talk about next steps, I recommend that companies prepare for the compliance and reporting requirements,” said panelist Alexis DeLuca. “Inevitably, whether a large business chooses to pay or play, they’re likely going to end up with a larger reporting burden than they planned for.”

According to DeLuca, businesses should take steps to ensure they are ready to comply with the changes as they roll out. Investing in the infrastructure needed to accurately report, capturing the required data and planning ahead for annual assessments of health insurance options by contacting an insurance broker or a tax advisor will help large businesses manage the impact of Affordable Care Act.

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: healthcare reform, Affordable Care Act, health insurance, insurance broker, Health plan, ACA, healthcare exchanges, NetMinder

 

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