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The NetMinder Blog

4 Ways to Measure Network Strength

Posted by Susan Donegan on Thu, Sep 14, 2017

The health insurance industry has developed a spectrum of network analysis tools to demonstrate a network’s breadth and depth, and to differentiate between networks.There are 4 common methods of network analysis widely used to evaluate health-related insurance products today. We visualize this spectrum as a pyramid to show how frequently the analysis is used and how specific the information is to each company. As you ascend the pyramid the frequency of availability decreases but the knowledge gained becomes more specific and as a result is more valuable to the overall assessment of the networks under consideration.4 ways to measure network strength.jpg

For example, at the bottom of the pyramid, measuring network size is fairly easy and is used in almost every analysis; it’s not very specific to a particular client or prospect. At the top of the pyramid, re-pricing the claims of the incumbent carrier is more difficult to do because it requires more data and cooperation from the prospect and the incumbent, therefore it’s done less frequently. However, when done, it’s very specific to the prospect’s situation. 

Download our whitepaper, The Network Analysis Pyramid for an overview of the most widely used methods to analyze provider networks.

Tags: compare networks, health insurance, network comparison tool, data analysis, network data, provider networks, repricing analysis

Accurate Provider Directories Make Network Comparisons Easier and More Compelling

Posted by Laura McMullen on Mon, Oct 17, 2016

Provider directory accuracy is an important topic for consumers, providers, and payors. It’s obviously very important to us, too – in fact, nearly half of our employees are focused on data accuracy and integrity every day.healthcare_directory.jpg

That’s why we’re following the progress of federal and state regulatory initiatives around ensuring accuracy very closely. I came across an article from Medicare Advantage News (login required) recently that summarizes official remarks at the Medicare Advantage and Prescription Drug Plan fall conference discussing the pilot program conducted by CMS’ Medicare Drug & Health Plan Contract Administration Group to assess directory accuracy. In this initial program, they found:

  • Nearly half (46%) of locations had errors meaning that at least one data element in the directory for that location was inaccurate. Most of the organizations reviewed were 20%-60% inaccurate.
  • Two-thirds of the deficiencies involved listing providers at locations where they don’t practice.
  • Ten percent of the deficiencies were incorrect phone numbers.
  • Twelve percent of the deficiencies were incorrect addresses, including incorrect suite numbers.

The study focused on large organizations with multiple locations and many providers, ultimately contacting nearly 6,000 primary care physicians, oncologists, ophthalmologists, and cardiologists at 11,646 locations. Based on our experience with directory data, inaccurate data is more likely with large practices that include many providers and locations. Take a look at our whitepaper about overstated access in dental directories for more on this subject.

Inaccurate provider directories frustrate members and providers and they also make it hard to compare your network to your competitors’ networks. Here are five best practices for managing your network data that will help you find inaccuracies in your network and make your network stand out:

  1. Review your directory data regularly. Be sure that provider names, addresses, and phone numbers are up to date. Transparency in your reporting will be to your advantage in the long run as it increases member and provider satisfaction by making your directory more reliable.
  2. Check for duplicate records that can be consolidated, especially if you are stacking networks, since it can be hard to identify providers from the vendor network that are already in the carrier network. This will also help streamline your directory validation programs.
  3. Adopt data standardization practices, particularly for numeric fields. For example, make sure leading zeroes on ZIP codes have not been dropped and replaced by the first digit of the ZIP+4. This is common in ZIP codes in New England, New Jersey, and US Caribbean territories. Cleaner data is easier to manage and compare.
  4. Consider including competitor network data in your analyses so that you understand your competitive position, predict results, and prepare for the future.
  5. For Disruption Reporting and Repricing, make sure that provider name data is properly parsed and address data is standardized. Use the same processes for claim and provider data files to give best chance of identifying valid matches.

How are you validating the provider demographic information in your online directory?

Tags: data analysis, network data, network comparisons, provider directories, directory accuracy

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

Dentists participating in more networks than ever

Posted by Laura McMullen on Thu, Jun 18, 2015

When we completed our annual review of dental PPO network trends based on the network data in NetMinder, two things really stood out:

  • The average dentist participates in 8 of the top 15 national dental PPO networks. 
  • Since March 2011, the number of dentists in more than 11 networks has grown by 15 percentage points.

dental_combo-1

The driving force behind these numbers seems to be the proliferation of lease and swap arrangements in the dental benefits industry. A dentist joins a network and then that network is leased to several other carriers so the dentist is now in multiple networks.

These arrangements enable rapid network growth by adding large groups of dentists at a time and make it easier to match competitors. In the past, dental benefits companies partnered with network leasing companies, such as DenteMax or PPO USA. Now we are seeing carriers swap networks like United Concordia and DNoA.

Maximizing the overlap between carriers is a sound strategy in a market where takeover business is predominant. Since the 2014 NADP State of The Dental Benefits Market study shows that 61% of Americans have dental insurance, this seems like the right strategy for right now.

How are these larger dental PPO networks playing out in your book of business?

Tags: dental network, network data, dental PPO networks, dental benefits, dentists

Flexible Geographic Groupings in NetMinder

Posted by Laura McMullen on Mon, Dec 22, 2014

Competitive network data is valuable to a variety of people in the employee benefits industry. The most common uses we see are sales people comparing networks for a current or prospective customer or broker, or network managers building recruiting lists. Some marketing departments use competitive network data in collateral and strategic planners use it to help chart the way forward.

This wide variety of users has an equally wide variety of preferences. Like many other systems that include geographic analysis, NetMinder uses standard groupings – from the whole country down to a single five-digit ZIP code – to make it easy to match up with other datasets such as procedure-level cost data, membership counts and employee populations. But sometimes you need to slice the data a little bit differently. Maybe you have sales regions that include several states or underwriting zones made up of three-digit ZIP codes. That’s why we added custom geographies.

Here’s what custom regions (groups of states) look like in NetMinder. In this example, the client included 6 states in their Mid-Atlantic region:

custom_geos

You can also set up groups of three-digit ZIPs as markets and groups of counties as territories. There’s no limit to the number of custom geographies NetMinder can support.

Customers love the flexibility custom geographies add to NetMinder. The business information lead for a large national dental insurer tells us: “It is helpful because we are able to focus our reports to match our internal geographical breakouts. We could run the same reports by choosing the 3-digit zip codes that correspond to each area, but having them already grouped for us saves a great deal of time. It also allows us to combine multiple geographical groupings into one report. It is a very beneficial tool for how we do business.”

Some other uses for custom geographies that we’ve found are:

  • Focused recruiting efforts
  • Evaluating network capacity and competitive position to support sales prospecting programs in defined geographies
  • Reporting on network size or makeup in service areas for regulatory and compliance needs

How do you group geographic data when you compare provider networks? What other pieces of data are important to your analysis and how do you match the datasets up?

Tags: network growth, compare networks, network data, network comparisons, Custom Geographies, NetMinder new features

Five Best Practices to Use Network Data to Grow Your Business

Posted by Darrin Hall on Thu, Jun 26, 2014

There are many factors employers consider when selecting an insurance carrier: price, benefits, service reputation and, to an increasing level of scrutiny, provider network. Positioning your provider network as the best fit for a client or prospect can make all the difference in winning the business.

Provider networks have to satisfy customers and members on multiple levels: 

  • Wide range of choices: multiple general and specialty providers are included in the network
  • 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
  • Cost-effective: in-network providers offer meaningful discounts that reduce out-of-pocket expenses and claim costs

Because the provider network is hard to measure and so important to winning and retaining business, the industry has developed four types of network analysis:network analysis pyramid

  • Network Counting – measure the quantity of providers in each network
  • Accessibility Analysis – correlate network provider locations to employee home and work locations
  • Disruption Reporting – match historical provider utilization and claims experience for a group to the providers in a different network
  • 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

Download our whitepaper, The Network Analysis Pyramid, to learn more about each method.

Insurance companies and network leasing partners are both the source of the data in these reports and the consumers of the analyses during their sales processes. This dual role provides incentive to invest the resources needed to prepare and maintain network data so that they are in the best position to win new business.

So, what can you do to show your network in the strongest position?

Here are five best practices for managing your network data that will give you the best results in your network comparisons.

  1. Review your directory data regularly. Be sure that provider names, addresses, and phone numbers are up to date. Transparency in your reporting will be to your advantage in the long run.
  2. Check for duplicate records that can be consolidated, especially if you are stacking networks, since it can be hard to identify providers from the vendor network that are already in the carrier network.
  3. Adopt data standardization practices, particularly for numeric fields. For example, make sure leading zeroes on ZIP codes have not been dropped and replaced by the first digit of the ZIP+4. This is common in ZIP codes in New England, New Jersey, and US Caribbean territories.
  4. Consider including competitor network data in your analyses so that you understand your competitive position, predict results, and prepare for the future.
  5. For Disruption Reporting and Repricing, make sure that provider name data is properly parsed and address data is standardized. Use the same processes for claim and provider data files to give best chance of identifying valid matches.

Earning new business and retaining current customers are the lifeblood of every company. Improving your position by cleaning and maintaining your network data can make it easier to do both.

What process do you use today to manage your network data?

 

Tags: network providers, health insurance, network comparison tool, disruption reporting, network data, network management, network leasing companies, provider networks, insurance companies

 

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