A disruption report is a network analysis technique that “correlates past provider utilization and claims experience for a set of employees to providers in another network.” Brokers utilize disruption reports to determine which carriers have the majority of a given employee group’s providers. A carrier’s network can be excellent, but if every employee has locate a new dentist in order to be covered, they will have a terrible experience. The disruption report is a list of the most frequently used providers (provided by the broker and employer group) that the carrier compares to their networks to see how many employees’ care will be disturbed by switching networks. You may download Netminder’s whitepaper on disruption reports for a more in-depth look at disruption reports.
What is a disruption analysis in healthcare?
Health plans can use Disruption Analysis to promptly respond to requests for proposals from benefits consultants and employers without having to hire additional people or spend more money.
What is a GeoAccess report?
These tools can also help you figure out how much money you could save by switching to a different health plan.
“These are significant decisions that employers make in order to keep their employees happy and keep money in the bank for other purposes,” says Ann Henry, senior proposal coordinator at HealthLink.
Smart Business spoke with Henry about the data provided by GeoAccess reports, disruption analyses, and requests for proposals (RFP), as well as how to use it to make smarter decisions.
The importance of timing cannot be overstated. Employers typically request an analysis a year to six months before their effective date, which is the first day of their health plan each year. The majority of businesses choose to align this day with their annual budgets.
Some employers procrastinate until the last possible moment. However, starting the process six to nine months before the plan’s effective date allows for full study and excellent decision-making.
An employer can use a GeoAccess report to see if their employees have good access to the provider network.
The report analyzes the employees’ zip codes and calculates how far they’ll have to drive to get to a network hospital or physician. The report indicates how many hospitals, primary care physicians, and specialists a particular percentage of employees have access to.
It’s vital to use in-network providers since it saves everyone money, and some health plans won’t pay claims for physicians who aren’t in the network. For example, if an organization orders a GeoAccess report and discovers that 10 employees must travel too far to view a network provider, it’s a good sign to keep looking.
Because most individuals enjoy their doctors and don’t want to change them, a disruption study shows an employer how disruptive it will be for their employees to use a different network of providers.
The study can connect providers used by employees to the future network of providers by looking at the employer’s claims activity for six months to a year. This defines what percentage of the providers in this network are also members of the other network.
It’s possible to take the analysis a step farther. The research can also estimate how much the claims would have cost with the new network if the claims data includes the billed amounts of the claims. Using historical claims data, this gives the employer an idea of what kind of discounts they would have obtained with an alternative network. It can help organizations figure out if switching to a different network of providers will save them more money.
Employers should consider what they enjoy about their current health plan and ensure that any new plan retains the same characteristics. They must also consider what is lacking or where problems have occurred, and how a new health plan can lead to changes.
Network discount information should be handled with caution by employers and brokers. A network discount can be calculated in a variety of ways, with different definitions yielding different results. When an employer thinks they’re comparing apples to apples, they’re not. The second thing to ask when an employer or broker requests network discounts is, “How did you come up with this discount?”
What is provider discount?
A provider discount is the difference between the charge rate for health care services and the contractually established reimbursement rate for an insurance carrier. The reduced rate will be used to calculate the patient’s liability, which will be determined by the deductible and/or coinsurance.
How do you prove disruption?
The next stage is to show that the events in issue resulted in business disruption and lost productivity. The finest claim you can make will go into as much information as possible about each particular occurrence and the outcome. The quality of the records, the number of incidents, and the amount of the loss the party is seeking to recover will determine if this is possible and whether it is cost-effective or proportional.
What else can you do if a thorough and well-thought-out claim for each specific occurrence is impracticable or disproportionate?
The SCL Protocol includes a table of probable approaches, which are divided into two categories: productivity-based and cost-based methods:
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Productivity-based strategies, as stated in the SCL Protocol, aim to measure and price the loss of productivity of utilised resources. Cost-based studies attempt to determine the difference between actual and projected costs without first calculating productivity losses in the used resources. 11
In general, the easier the approach for proving disruption, such as industry studies (which approximately compare the productivity levels on site with those discovered in industry studies for similar works) or a pure total cost allegation, the less likely it is to succeed. A pure total cost claim that makes no attempt to establish causality is essentially a mud-slinging exercise. “I intended to spend x, but I spent Y, and here are ten reasons that are your obligation under the contract, and I claim the difference between X and Y from you,” for example.
The “measured mile” is perhaps the most well-known way for assessing disturbance. A measured mile analysis looks at productivity levels during an activity or time period with no interruptions. The “measured mile” therefore serves as a benchmark against which the disruption’s impact can be quantified. The difference in resources expended (work, plant, materials, etc.) can then be calculated.
According to the SCL Protocol, this is one of the “most trustworthy and accurate project-specific studies,” but only if “fully implemented.”
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For a variety of reasons, finding a measured mile can be challenging. For example, if records were not preserved, showing that you could reach the productivity rates specified in the tender would be challenging. Similarly, if the disruption is especially severe, there may be no comparable undisturbed mile to compare to. There may be no standard piece of works or too many varied “measured miles” to make a measured mile or multiple measured miles viable if the works are complex.
Whatever method of analysis is chosen, it is critical that it rests on a solid foundation of reality based on contemporaneous data and witness testimony. It’s also a good idea to double-check the results. Particularly if the tender was light or if there were discrepancies within the available measured mile, they must be acknowledged and addressed.
His Honour Judge Stephen Davies wrote in Amey LG Ltd v Cumbria County Council13 that:
“What is known as the’measured mile’ approach,… should have been verified by being able to demonstrate that the planned outputs were actually achieved in some cases where the disrupting events did not occur… it should have been relatively easy, using the contemporaneous records that were produced, to conduct a cross check on a suitable sample basis…” It appears to me that demonstrating this… would have been a quite simple exercise… to conduct an appropriate sample exercise, which would have assured that any danger of individual variances would have been detected and addressed.”
The crucial point is that expert testimony is only the icing on the cake in terms of the disruption case. The key to success is the factual evidence that goes along with these types of analyses.
What is geo access mapping used for?
GeoAccess, Inc. was the first company to study the accessibility of health care networks using geographic data. Prior to GeoAccess’ work in the early 1990s, health care network accessibility was calculated by comparing zip codes of providers and customers.
GeoAccess created software that allowed the accessibility of health-care networks to be precisely quantified using the geographic coordinates of health-care provider locations.
For the first time, businesses and government-sponsored programs could set access rules that consider the actual accessibility of health-care providers when deciding on health-care networks.
GeoAccess-based analysis had become the industry standard for assessing the accessibility of health-care networks by the mid-1990s.
What is geo access mapping?
The process of creating a map using location-based data (names, addresses, sales numbers, demographic information, etc.) is known as geo-mapping. By visualizing all of the data you’ve gathered, you’ll be able to detect crucial trends and new business opportunities.
Let’s imagine you want to look into the sales in one of your territories. The figures appear to be excellent on paper. The territory is doing well, and sales are exceeding your expectations. There doesn’t appear to be anything that can be done to improve things.
Can you negotiate health insurance deductible?
You won’t be able to bargain all of your medical bills, but you will be able to negotiate some. Insurance copays and deductibles are unlikely to be negotiated, especially if your practitioner is in-network.
Taking this step could jeopardize their insurance contract with you. However, depending on whether your insurance contract calculates these numbers in percentages or real dollars, they may be willing to reduce your overall amount, which could alter your copays and deductibles.
Can you negotiate health insurance rates?
The purpose of health insurance for businesses and employers is to lower their spending on employee benefits without compromising the benefits themselves. Employers are turning to referenced based pricing to help them turn around and save money on claims.
Employers, on the other hand, can better control claims costs with Referenced Based Pricing by starting discussions with the lowest available prices. These claims include costly procedures, hospital stays, and treatment alternatives that are often more expensive, though prices vary.
Insurance companies set their own pre-negotiated discounts for each service the hospital or network provides under this pricing model. This determines how much you’ll have to pay.
How can I lower my health insurance deductible?
HSAs, or health savings accounts, are accounts used to pay for medical bills. A health savings account saves you money on taxes since the money you put in and take out is either tax-free or tax-deductible.
You can reduce your monthly payment as well. Plans that include a health savings account have greater deductibles, resulting in lower rates.