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The NetMinder Blog

Which Provider Counting Method Do You Prefer?

Posted by Aaron Groffman on Mon, Dec 09, 2013

I asked attendees at my recent NADP CONVERGE 2013 break-out session which counting method they prefer to use for comparing provider networks, and the majority answered “unique providers.”

Counting Methods in NetMinder Dental PPO Reports

Based on NetMinder user data (as illustrated in the chart), access points (each provider at each of their locations) is still used about half the time, but the unique providers counting method is catching up.  In 2012, 36.7% of NetMinder dental PPO reports used unique providers as the counting method, and 53.7% used access points. This year we started to see a shift, with 40.9% of reports using unique providers and 50.7% using access points.

It makes sense that unique providers would be the preferred counting method for NADP attendees, who tend to be senior level managers looking for a big picture view of how their company is performing. Using unique providers simplifies the equation because it means each provider is counted once regardless of how many locations he or she is listed at. This eliminates duplication caused by a) associates who change offices and b) providers who are listed at multiple locations to facilitate claim payment.  Looking at access points with an overlay of our exclusive practicing locations indicator offers a similar view to counting unique providers with the added benefit of including multiple locations that have been validated by claim activity.

Which counting method do you prefer and why?

Tags: network growth, dental network, network providers, dental providers

More Health Systems Becoming Payers

Posted by Aaron Groffman on Thu, Sep 05, 2013

More than 20 percent of hospitals and health systems in a recent survey said they are planning to launch a health insurance plan by 2018.

Another 34 percent of respondents said they already own health plans. The June 2013 survey was conducted by by the Advisory Board Co., a Washington, D.C.-based research and consulting firm, and included more than 100 U.S. hospitals and health systems.

Health insurance exchanges, the aging boomer population, increasing cost and reimbursement pressures and an industry-wide move toward population health are driving many health systems’ decisions to become payers, despite the risk of that move in the continually changing healthcare industry.

North Shore-LIJ Health System, a Long Island, NY-based hospital system, plans to offer its health plan called CareConnect on the state health insurance exchange beginning October 1st.

Providers that offer health insurance typically offer a narrow network composed of their own hospitals and affiliated physicians. But in order to be successful, a network must include enough facilities and physicians to provide access and member convenience. Therefore, some health systems are joining forces to create health plans with stronger networks than either could offer on its own.

For example, Piedmont Healthcare and WellStar Health System, two Atlanta-based systems, are partnering on a health plan called the Georgia Health Collaborative that will offer commercial and Medicare Advantage products starting in 2014.

If you were starting a health plan, how would your network compare to your competitors?

Tags: network growth, network providers, health insurance, Affordable Care Act, Healthcare, Healthcare, healthcare reform, health reform, healthcare benefits, Obamacare, health insurers

New Whitepaper Clears Up Changing Vision Market

Posted by Aaron Groffman on Mon, Jul 01, 2013

Clearing up the Vision Market white paperVision insurers, medical insurers and insurance brokers will have a significant opportunity in the coming years as the growing market and changing make-up of vision care delivery impact vision care plans.

Vision care products and services are delivered at more than 47,000 U.S. optical locations, ranging from sole practitioners to mass merchandisers.  The market includes independent eye care professionals (ECPs) and retail chains. Market share indicators and loyalty metrics, such as the Net Promoter Score, show that consumers prefer ECPs for exams, but they more often choose retail chains for frames, lenses and contacts.

It’s clear from consumer purchasing preferences that managed vision care plans will need to include a combination of ECPs and retail chains in their provider networks to service the preventive and routine vision care needs of their clients.  The question is: what’s the right balance? 

To answer this question for your company, you first need accurate provider network data. Gathering and maintaining this information on your own can be expensive, time consuming, and subject to inaccuracy. The good news is we can help. Tracking more than 250 networks from national, regional and local vision, medical, dental, and behavioral plans across the country, NetMinder gives payers, brokers and consultants an objective, consistent, validated source of provider network data to use as they guide their customers in making smart employee benefit decisions.  

Download our new whitepaper, Clearing Up The Vision Market, to learn more about how the vision market is changing and what these changes mean for your company.

Tags: network providers, vision market, Vision insurance, consumer choice

2 Keys for Growing Provider Networks

Posted by Aaron Groffman on Fri, May 10, 2013

NetMinder data often reveals interesting patterns that we like to share for the benefit of our users and readers. For example, reviewing data about provider network participation revealed two important patterns that could make growing provider networks easier for insurers.

  1. Tips on Growing Provider Networks from NetMinderFind the newbies. Providers who recently started joining networks are more likely to join more. They’ve embraced the concept and may be ripe for your call.
  2. The more the merrier. Providers with a large number of network contracts are more likely to sign another. They understand the process and see the value of participation.

Finding providers with these attributes can pave the way for recruiting success. Have you noticed any other interesting and useful patterns when developing your networks?

Tags: network growth, dental network, network providers

3 Steps to Using Competitive Network Advantage to Win More Business

Posted by Aaron Groffman on Thu, Apr 11, 2013

Helpful Tips

I’m often asked how to use a competitive provider network advantage to win more business.  As I talk to NetMinder users, one of the best and easiest ways I hear is to leverage your network advantage to negotiate for better rates for prospects in your sales pipeline.  Try these three steps:

  1. For key prospects, assess your network compared to competitors.  Do you have more providers in areas with significant concentrations of your prospects’ employees?  Are you the market leader?
  2. Provide this data to your underwriting team.  Stress the expected higher in-network utilization and lower claim costs that will result.
  3. Demonstrate to your prospect how your network advantage will save them money.

As I wrote in Chapter 7 of Dental Benefits: A Guide to Managed Plans, the network is the product.  A competitive provider network strengthens your sales pitch! Try this approach and let me know if you see results.

Tags: network providers, dental insurance, insurance broker, Ancillary benefits, Vision insurance

Is the Health Insurance Company a Good Friend?

Posted by Aaron Groffman on Fri, Mar 08, 2013

Medical 000005787159Medium(2)The next decade will be about bringing down the costs of health care in the U.S., says venture capitalist and blogger Todd Hixon, in a recent Forbes article titled “The Health Insurance Company Is Your Friend.” The biggest drivers of healthcare spending in the U.S. are the over-utilization of advanced medical care and the high earnings of the providers of that care, he says.

It’s payers versus providers, and health insurers are in the payers’ corner.

Hixon shares one of his own healthcare experiences in which “the insurance company paid about 30% of the face value of the bill, due to a combination of lower negotiated prices and striking off major billing errors and duplications.” 

The takeaway for insurers is that finding the right network providers is more important than ever. Insurance companies can help keep healthcare costs down by shifting away the high-end risk as well as building provider networks with good value for the cost, Hixon says in his follow-up article. Look for providers who offer good discounts, have a good utilization track record, and who participate with other networks so they know what’s expected. 

This is the right dynamic: how the insurance company becomes a better friend.

Tags: network providers, health insurance, Healthcare, dental insurance, health reform, health insurers, payers




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