Any company that wants to optimize its health benefits plan in the twenty-first century needs expert data analytics in their corner. The complexity of robust health plan data analytics often requires deep expertise well beyond the in-house capabilities of most businesses. The good news is that LHD has been focused on generating proactive, data-driven, actionable insights for its clients since its founding at the turn of the millennium. We’ve continued to grow and deepen our capacity for data analytics ever since, and our clients reap the benefits of more cost savings and better health outcomes for their employees.
A critical piece of the analytics puzzle is our health plan network analysis data service. After all, the overall quality of any company’s health benefits plan is going to depend in large part on the quality of the network of providers employees utilize to receive their healthcare.
The Relationship Between Health Plan Quality and Network Quality
It would be a grave mistake to underestimate the role a provider network plays in the quality of employer health plans. The quality of a health plan a business provides to its employees is only as good as the provider network of healthcare professionals and facilities providing the care people need.
Despite the obvious and unavoidable link between a health benefits plan and its provider network, you’d be surprised how many businesses overlook provider network analysis as an essential part of optimizing plan performance. Given the ever-rising cost of healthcare, employers must put healthcare networks under the analysis microscope to see what’s really going on, because it’s impacting the quality of their health plans whether they’re aware of it or not.
Provider Network Accuracy and Adequacy
Two essential aspects of provider network quality that must be carefully examined are network adequacy and network accuracy. When either of these elements are subpar or less than optimal, the result will be higher health benefits plan costs to a business over time.
The Adequacy Factor in Provider Network Analysis
Network adequacy refers to how robust the population of healthcare providers is in the network. Some provider networks have become too narrow. They may have a robust membership roster of expensive specialists but are slim on general practice providers. This creates several problems for an employer’s health benefits plan. When employees need medical care that ought to be easily provided by a general practice provider but can’t find one in the network, they may end up seeking the care they need through emergency room visits, the costs of which quickly mount for the employer’s health plan. They may also end up booking an appointment with a provider who isn’t in the network without realizing it and wind up with surprise medical bills they were not expecting and which can become a real hardship.
Other aspects of network adequacy that impact access to healthcare include the raw number of providers/facilities as well as the geographic distribution of providers in the network. Network analysis should be based on at least the minimum requirements of Medicare Advantage applicants. They are required to demonstrate there are enough facilities and providers in the network to meet minimum access standards for both current plan participants as well as potential enrollees. They must also show that the geographic distribution of in-network providers doesn’t unduly burden plan participants in terms of distance and travel time. After all, what good is an in-network provider if employees can’t get there easily to receive care?
The Accuracy Factor in Provider Network Analysis
There’s an epidemic of inaccuracy in provider network data, which can have huge impacts on access to healthcare and the quality of the employee experience of the company health plan. CMS studies have revealed that only 30–40% of a health plan’s provider data is accurate, nearly 42% of all provider directories contain errors, and close to 49% of provider locations contained at least one error, 41.75% of provider locations had errors that would likely prevent access to care. This should be considered unacceptable.
The inaccuracies rampant throughout network provider data include listing inactive providers who have retired or died, providers being listed at an excessive number of facilities (which signals location inaccuracies), strange and highly unlikely specialty combinations (such as neurologist and dermatologist), providers listed in the plan’s network who are in fact not in the network (which can result in surprising billing to plan participants), wrong telephone numbers, listing providers as accepting new patients when they aren’t, and the list goes on.
At the barest minimum, network data accuracy should be verified quarterly. That’s the minimum standard for Medicare plans. Think about the negative impact these provider network data mistakes have on the member experience. It makes people angry when they can’t get the care they need, or they receive care and then must deal with a surprise medical bill they weren’t expecting. Most employers want to do much better by their employees, which is why careful network analysis is needed to ensure your company and its employees are being served with accurate provider data. We view an employer health benefits plan as an investment into employee well-being, but the return on investment will decline if employees have negative experiences due to bad provider network data.
LHD: The Relentless Pursuit of Excellence in Health Plan Data Analytics
At LHD Benefits, we’ve built a solid reputation for doing right by our clients. A big part of our success is a tireless devotion to proactive data analytics. With so much data available in the digital age of the twenty-first century, we recognized early on how it could be leveraged into actionable insights to help companies make better and more strategic business decisions about health benefit plans, contain costs, achieve better health outcomes for employees, and realize the full power of high-performing health plans.
If the time has come to optimize your company’s health benefits plan, LHD has the expertise and commitment to excellence in customer service to make it happen. We help businesses from small to large achieve the best mix of cost control measures and quality healthcare for employees to maximize the return on a company’s investment into workforce well-being. We hope to hear from you through the Contact page of our website, by telephone at 371.751.7049, or by email at email@example.com. We’re eager to discuss your company’s health plan needs and how LHD can help.