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The NetMinder Blog

Do We Count Access Points or Unique Providers?

Posted by Laura McMullen on Thu, Feb 08, 2018

This question has been around since the first time someone decided to compare two provider networks. In fact, NetMinder wouldn’t be here without it! One of our founding principles is a commitment to comparing apples to apples. This thread runs through all our processes starting with the way we collect data and ending with selecting report criteria. We’re focused on this idea because we know that how you count network providers can make a big difference in calculating network strength. Read our whitepaper about counting providers.

Choosing The Best Counting Method For Your Analysis

Each counting method has strengths and weaknesses. Access points is the broadest count with the highest numbers. It’s great for showing consumers where they’ll be able to access care. Unique providers (sometimes called “belly buttons”) is often the cleanest count and preferred by benefits decision-makers. It’s not so good for consumers since it doesn’t show all locations. Unique locations (sometimes called “doorbells”) is the narrowest count with the smallest numbers for obvious reasons.

One Report To Show Them All

Dental_Dashboard.jpegMaking sense of these options is why we added a new Dental Dashboard to our suite of snapshot reports. It shows all three counting methods plus validated counts and percentages for a single geographic area in the same report. The six bar charts bring access points, unique providers, and unique locations together for up to five networks. Watch this video to learn more.

Each counting method is important at different points in the sales and renewal process and the Dental Dashboard makes it easier to look at them all. For example, access points are important to consumers when they are making appointments while HR teams rely on unique providers to compare networks. This report helps you prepare for questions about both scenarios and encourages a broader view of the reliability, convenience, and strength of your network.

How are you counting and comparing the providers in your network?

Tags: access points, unique providers, counting method, compare networks, provider network, network strength, network providers, unique locations

Dental PPO Network Growth Rate Down While Locations Per Provider Increased Significantly

Posted by Laura McMullen on Mon, Oct 24, 2016

Our annual analysis of dental network trends showed overall annual growth in unique providers of ~7-8% over the last five years. By all measures, networks are growing.

Here’s the breakdown:

  • The average number of unique locations grew from 58K to 77K, or 33%
  • The average number of unique providers grew from 72K to 99K, or 37%
  • The average number of access points grew from 163K to 309K, or 90%

Top 15 Dental PPOs_mar 2016.jpgNot only are there more locations and more providers, but there are also more locations per provider: up 38% (2.25 to 3.12) from March 2012 to March 2016.

And yet, when we did this same analysis in 2015, we saw 10% annual growth in unique providers over the prior five years. While the growth was higher in access points and lower in unique locations like it is this year, all of the percentages were higher:

  • The average number of unique locations grew from 54K to 76K, or 41%
  • The average number of unique providers grew from 67K to 100K, or 50%
  • The average number of access points grew from 134K to 281K, or 110%

Interestingly, the average number of locations per provider only grew 29% (2.01 to 2.82) between March 2011 and March 2015.

So if the annual growth rate is lower, and the overall growth in each counting method is less, why did the average number of locations per provider grow 33%?

The multiplier effect we were starting to see in 2015 has blossomed. Just one of the 15 largest national dental PPO networks doesn’t have any lease partners and the other 14 have increasingly more complex network stacks. On average, the largest networks have four network partners and four networks have six partners. Connection Dental, DenteMax, Maverest, and Stratose are the most frequent network partners.

Another factor is the number of networks each dentist is joining. In our analysis, we found that the average dentist participates with 55% of the top 15 dental PPO networks, while nearly half of dentists in networks are in at least 11.

One more element of the growth is the rise of dental service organizations. We’ve seen a decade of private equity investment and that’s paying off. Becker’s Hospital Review noted that a 2014 Sageworks analysis found that DPMs generated the highest return on equity of the industries it examined. With additional cash, DSOs are growing by building and acquiring dental practice. And following the industry practice of listing each provider at each office contributes to the increase in locations per provider.

How are these trends playing out in your networks and markets? About 40% of dentists participate in 1-4 networks, so there is still room for organic growth. How well are both tactics represented in your strategic plan?

Tags: dental network, counting method, network providers, dental PPO networks, network growth

Focusing on vision networks

Posted by Laura McMullen on Tue, Jul 07, 2015

A few years ago, we published a whitepaper called Clearing Up the Vision Market. Since then, the demand for vision networks has increased significantly with the number of people who take a vision plan when it’s offered growing from 78% in 2012 to 83% in 2013 in a 2014 SHRM study on vision care, so we decided to take another look.

As of March 2015, there are 48,000 optical locations in the top 10 national vision networks. They fall into two categories: independent eye care professionals (ECPs) and retail chains.

  • ECPs are defined by VisionWatch as having three or fewer locations with an ophthalmologist, optometrist, an optician, or an optical retailer on site. Nearly all ECPs are small businesses.  According to a whitepaper sponsored by Vision Source, ECPs are typically single location operations with less than $1.5 million in annual revenue and 12 or fewer employees. They have been in practice on average for 20 years.
  • Retail chains have 4 or more locations and may or may not have an ophthalmologist or an optometrist on site. The best-known brands in this category are widely available, such as LensCrafters, Pearle Vision, Walmart, and Costco.

ECPs make up two-thirds of locations and 45% of market share while retail chains are the rest. A recent Bain and Company study shows the second most influential factor (after cost) in selecting a managed vision care plan is the retail network the plan provides. This helps explain why retail chains account for 55% of vision sales, with only one-third of the locations.

A Consolidating Market

In a recent Wall Street Journal blog post, Optometrists Catch FFL’s Eye, Thomas Puckett of merger and acquisition advisory firm HPC Puckett & Co., said “There aren’t many operators with over 100 locations, but there are quite a few independents with under 50 locations. It is logical for businesses to consolidate in a geographic area.”

Private equity firms are projecting that the number of retail outlets will drop by half over the next five years through consolidation. Investors are most interested in firms valued at $10 to $50 million and the expected growth from the Affordable Care Act and the aging US population makes the industry even more attractive.

Other Vision Network Trends

A recent review of the top 10 national vision networks in NetMinder found some interesting trends:

top_10_vision
  • Vision networks are growing. The number of unique providers in these networks grew about 8% annually from 2011 to 2015. Unique locations grew more slowly (3% annually) and access points grew more quickly (11% annually). This is most likely because retail chains, such as Pearl Vision or Lenscrafters, generate more revenue with fewer locations.
  • Some ECPs practice at many locations. On average, ECPs are listed in provider directories at 2.4 locations with a range of 1.6 to 3.2 locations. This could be the beginning of a trend toward overstated access in vision networks. We see about 25% access point inflation in dental PPO networks and have put a validation process in place using claim data to adjust counts. We are watching vision networks closely to see if a similar filter is needed. 
  • vision_networksECPs are joining more networks. In March 2011, the average ECP participated in 2.5 networks. By March 2015, that count was up to 3.7 networks. This shift is quite dramatic: five years ago 75% of eye care providers in these networks were in 1-3 networks and now only 53% are while 15% are in 7-10 networks.


Are you seeing these trends play out in your network? Are vision benefits in demand among your customers and their employees?

Tags: network providers, Affordable Care Act, optical retail, Vision insurance, healthcare benefits, Managed Care, employee benefits, vision networks, practicing locations, Vision

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

Five Best Practices to Find the Right Provider Network for Your Customers

Posted by Laura McMullen on Thu, Jul 24, 2014

In a recent blog post entitled, Five Best Practices to Use Network Data and To Grow Your Business, we wrote about the ways carriers and network leasing companies can improve their position in network comparisons by better cleaning their data. Another point of view is from the brokers and consultants who use network analyses to help their customers choose the right benefit plans.

health insurance plansShopping for employee benefits is complicated and time consuming. Employers and other plan sponsors typically rely on a broker or consultant to help them through it. Brokers and consultants know that network issues can turn a satisfied customer into one that goes out to bid in the blink of an eye. Even if everything else is right: price, benefits, service, and timely and accurate claims payments can’t outweigh a network that doesn’t fit the employee population.

As we pointed out in our other post, the best networks:

  • Offer a wide range of choices: multiple general and specialty providers are included in the network
  • Are 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
  • Save employers and employees money: in-network providers offer meaningful discounts that reduce out-of-pocket expenses and claim costs

Depending on the number of employees your customers have, different types of network analyses are probably available from your carrier partners. Generally, we see four types of network analysis:

  • Network Counting – measure the quantity of providers in each network (available for groups of all sizes)
  • Accessibility Analysis – correlate network provider locations to employee home and work locations (available for groups of all sizes)
  • Disruption Reporting – match historical provider utilization and claims experience for a group to the providers in a different network (available for groups with at least 200 employees)
  • 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 (available for very large or self-funded groups)

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

As the primary users of network analyses, brokers and consultants are in a unique position to influence the requirements of each type of analysis. Keep these five best practices in mind as you work with carriers on your customers’ behalf:

  1. Insist on clean, accurate data so you get clean, accurate reports.
  2. Clearly identify required fields and formats in all file requests.
  3. Obtain claim data from the incumbent carrier whenever possible.
  4. Choose a consistent counting method for all reports to ensure that you are comparing apples to apples.
  5. Evaluate key specialties separately from the overall network based on your client’s needs.

With all of the changes from the Affordable Care Act, employers and other plan sponsors are relying on brokers and consultants more than ever.

How do you evaluate networks today?


 

Tags: Healthcare, healthcare reform, Affordable Care Act, health insurance, health reform, data management, data analysis, network providers, health insurers, dental network, ACA, market comparison, network metrics, compare networks, healthcare exchanges, network comparison tool, network change, provider networks, disruption reporting

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

Measuring Productivity and Activity in Provider Network Recruiting

Posted by Laura McMullen on Thu, May 29, 2014

As you can imagine, we’re always thinking about building, maintaining, and selling provider networks. The most frequently asked question we get is how can I show my network in the best possible light; even if it isn’t the largest in a particular geographic area? One way is to look at recent growth (or contraction) trends.

There are several metrics that illustrate growth or contraction:

  • Adds: number of providers that were new to a network since the last update
  • Drops: number of providers that left a network since the last update
  • Net Change: difference between Adds and Drops
  • Total Change: total of Adds and Drops

Each metric has value, depending on the analysis you are doing. For example, simple counts of Adds and Drops measure the activity in a network while Net Change shows growth over time.

The Network Change reports in NetMinder analyze a network at two points in time. They bring all four metrics into one convenient report for selected specialties and geographic areas. Like other NetMinder reports, the summary report shows counts and the detail report gives lists of providers with their contact information. Watch a Quick Take video to see how the reports work.

Measuring Productivity Instead of Activity

network changeWe’ve all heard the expression “change for change’s sake” and know that’s not a good thing. In network management, the primary purpose of change is growth, so any change that doesn’t result in growth is potentially unproductive. That’s why we added the Network Productivity Index to the Network Change reports. This index compares net change to total change to measure how much activity is productive. The index values range between zero and 1; where 1 means that 100% of activities during the comparison period resulted in growth. For example, even though two networks in the same county are roughly the same size, Network A had fewer drops and less change resulting in an NPI of .42, significantly higher than Network B’s .04.

Measuring productivity is important because networks with high turnover may have higher rates. It costs more to recruit a new provider than to keep an existing one. Higher costs ultimately lead to higher rates so the more productive a network’s recruiters are, the more competitive the rates can be. And the ability to quickly replace providers who leave a network satisfies customers and members leading to high retention rates on the sales side, as well.

For more ideas about using network change metrics, download our whitepaper How Productive is Your Provider Network.

Which metric do you think is the most important metric in managing productivity for the networks you manage and sell?

Tags: network metrics, network rank, network providers, network comparison tool, network change, network management, network productivity, provider networks

How the Affordable Care Act (ACA) is Influencing Adult Dental Insurance Coverage

Posted by Laura McMullen on Thu, May 15, 2014

Adult dental insurance is a hot topic thanks to the Affordable Care Act (ACA) and Healthcare.gov. Under the new healthcare law, dental coverage for children 18 and younger is considered an essential health benefit that must be included in all plans sold on exchanges. For adults, it’s a different story: insurers don’t have to offer adult dental coverage, nor do adults have to purchase it.

dentistsThis situation could lead to fewer healthy adults purchasing dental coverage because their health insurance budget is committed to the mandated ACA coverage. This effect may drive up dental premiums for everyone if the pool of prospective purchasers consists only of those needing more extensive and costly dental treatments. From a network perspective, dentists may find themselves joining more networks to fill in the gaps and gain new patients.

Nancy Smith lays out the ramifications of ACA on adult dental coverage and concerns from dentists in this Sunshine State News article “Obamacare Leaves Gaping Cavity in Adults’ Dental Health”.

Individual Adult Dental Insurance Plans

Consumers may start looking for individual adult dental insurance plans. This is an opportunity to promote a variety of dental plans, ranging from discount plans to stand-alone insurance plans to dental benefits that are embedded in qualified health plans on exchanges. These plans can differ significantly from traditional, employer-sponsored dental plans and may require education to ensure member satisfaction.

dentist toolsFor example, “annual maximum” is an important term when talking about adult dental insurance. The annual maximum, or benefit cap, limits the maximum amount the insurer has to pay, making the consumer responsible for any additional costs beyond the maximum. Due to ACA, new health insurance policies do not include a benefit cap. However, for consumers looking for both health and dental insurance, benefit caps can still exist in adult dental plans under the name “annual maximum.”

Read more on this topic in the article “What is the Problem with Adult Dental Insurance Plans on Healthcare.gov?” by Naomi Mannino on www.mainstreet.com. Of course, consumers should check that their providers are in the network.

Voluntary Group Plans

In some cases, another option is voluntary group dental insurance. Caitlin Bronson, in Insurance Business America, reports that some groups are dropping health insurance plans so that their employees can use the exchanges but adding voluntary ancillary benefits, like dental and vision plans. She writes, “Roughly 80% of voluntary sales are dental coverage, with a projected 2% increase in 2014, Towers Watson found in its 2013 Voluntary Benefits Survey.”

These plans allow employers to offer a popular benefit and pass the cost along to their employees via payroll deduction, which in some cases eases the sting of changes in health insurance benefits. Some believe that voluntary plans don’t offer enough coverage for the cost to satisfy commercial clients and their employees.

With several options to choose from, will healthy adults opt for dental coverage?  

Tags: dental benefits, dental insurance, dental insurer, health insurance, healthcare benefits, network providers, dental network, dental providers, ACA, Affordable Care Act, compare networks

Narrow Networks Add Complexity to the Health Insurance Business

Posted by Laura McMullen on Thu, Apr 24, 2014

narrow networksThere’s been a lot of buzz in the media lately about narrow networks in health insurance plans on the federal and state health insurance exchanges. This has prompted a larger discussion about network adequacy and the trade-offs between cost control and choice. Carriers Defend Use of Narrow Networks as Fair, Market-Driven Options for Consumers, an article from Health Plan Week reprinted in AIS Health Reform Week on April 4, 2014, sums the situation up well, discussing network adequacy, consumerism, and transparency.

Here are some questions to think about when you are comparing provider networks, whether you are managing a network, selling insurance plans to employers, or purchasing a plan for your company or family.

1. Are the right types of providers in the network? When provider networks get narrower, the definition of network adequacy shifts from the size of the network to the types of providers that participate. Employers and other group benefit sponsors are asking questions like: Are there enough PCPs or optometrists? What about cardiologists or oral surgeons? How many radiologists or ER doctors are near my members? (Download our whitepaper All Provider Networks Are Not Created Equal for more.)

2. Is the carrier financially and administratively reliable? Narrow networks reduced one of the barriers to entering the health insurance market, namely the need to have a large provider network. Many new entrants to the market raise questions about financial solvency and claim payment speed. 

    • In the dental insurance industry, we’ve seen established brands like Prudential come back to the market with a leased network and outsourced back office only to exit after a few years. (See our blog post Prudential Exits Dental Benefits Market; Others to Follow? for more.) 
    • In the health insurance industry, more than 50% of hospitals and health systems responding to a June 2013 Advisory Board Co. survey said that they planned to launch a health insurance plan by 2018 or they already had one. (See our blog post More Health Systems Becoming Payers for more.)

3. Are the right providers in the network? From the consumer perspective, all networks are narrow – they only include the providers they use! Many people are accustomed to the large PPO networks that have been popular in employer-sponsored plans over the last several years, so they may be surprised by narrow networks that don’t include popular providers and academic medical centers. Communicating early and often, like B2C companies do, could make a big difference here. For more about how consumers look for health care information online, see our blog post Consumers Seek Real Data Online for Health Decisions.

Key questions for the Department of Health and Human Services in the coming weeks and months will be which types of providers are essential and how large is an adequate network. As they work on the answers for plans on the exchanges, carriers will be watching closely to see what the impacts are for plans off the exchanges.

How will you assess your network and your competitors’ networks?

Tags: healthcare reform, health insurance, health reform, network providers, Affordable Care Act, market comparison, compare networks, narrow networks, healthcare exchanges

All Provider Networks Are Not Created Equal

Posted by Aaron Groffman on Mon, Dec 23, 2013

Overlap between provider networks has emerged as an important metric in determining network strength.  NetMinder data on the top 15 national dental PPO networks shows that similarly sized networks can actually be quite different in terms of overlap, or how many providers they have in common.

Recruit Smarter, Not Harder whitepaper

Why is network overlap important? Here are three key reasons:

  • The dental benefits market is relatively flat. From 2002 to 2011, the percentage of the U.S. population with dental benefits has ranged between 54% and 58%.
  • Take-away business fuels dental plan growth.
  • Minimizing disruption for plan members is important if you want to take away business, and a higher rate of overlap with your competitors’ networks means less disruption.

Among the top 15 national dental PPO networks, the overlap in access points ranges from 39% to 68%, while the overlap in unique dentists ranges from 53% to 88%. 

The greater the overlap you have with as many networks as possible, the better positioned you are to take away business from your competitors.

Download our new whitepaper to learn how to “Recruit Smarter, Not Harder.”

Tags: dental insurance, network growth, dental PPO networks, network providers, dental network

 

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