provider impact analysis (aka narrow network)
DESCRIPTION
A service that will return a pinpointed list of providers that meet adequacy criteria if contracted. An awesome way to save time and money on recruitment.TRANSCRIPT
- 1. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Providers that Fit: Narrow Networks Strategies and Design
2. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 CONTACT US ANYTIME Darren Huff Regional Sales Director East Region [email protected] Linda Borths Director of Sales [email protected] John Weis President & Co-Founder [email protected] Robert Smith Regional Sales Director West Region [email protected] 3. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 BUILT with VISION QUEST ANALYTICS SUITE The industry's only software solution that has continued to evolve to meet the changing demands of Network Adequacy. The Quest Analytics Suite fully integrates; Access, Disruption, Network Adequacy (Medicare and Custom), Address-level Geocoding and Hospital Quality Analysis into one easy to use suite. ACCESS ANALYSIS Access Analysis Access Comparison Mapping ADEQUACY ANALYSIS Medicare Advantage Medicaid Dual Eligibles Exchanges Commercial RFPs GEOCODER & DATA STANDARDIZATION Address-Level Accuracy Data Standardization Zip Correction True County Assignment DISRUPTION ANALYSIS Transparency & Confidence Provider Change Analysis QUALITY ANALYSIS Hospital Quality Tiered Networks 4. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 National Marketplace Presence 5. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Whats Missing? 6. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 What Narrow Network Really Means Consumers MAY Consider $ in Plan Selection But They Will Stay Because of Access! 7. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 WHAT IF YOU COULD Prioritize new market efforts Predict recruiting resources & costs more accurately Change the market model Build quickly to minimum requirements Back-fill to market readiness Shift value to speed to Market 8. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Market Drivers UNDERSTANDING MARKET DRIVERS Filling Individual Specialty Gaps for Service Area Expansion New Market Penetration HealthCare Marketplace Preparation Hybrid Commercial Networks 9. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 RECRUITING CHALLENGES PREDICTING COST AND TIMEFRAMES Timeframes/Timeframes/Timeframes How to target providers How to prioritize resources How to incent providers In-house vs. outsource Predicting cost 10. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Expected Outcomes PREDICTING COSTS, REVENUES & TIMELINES Budget Dollars Resources In-House or Contract 11. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Provider Impact Analysis Reporting PROVIDER IMPACT ANALYSIS SERVICE Identifies and Prioritizes Markets Ranked and Ordered Analysis for Use In: Tiered Networks Minimizing Exchange Exposure 12. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 CASE STUDY: Filling the Gap(s) 13. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 SERVICE AREA EXPANSION Identified gaps for specialties Obtained recruiting list of targets Reviewed Narrow Network to rank providers to fill gaps 14. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 ANALYZING THE GAPS SCORECARD 15. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 REVIEWING VISUALLY 16. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 TRIED (but true?) 17. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 MEASURING IMPACT 18. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Narrow Networks: Ranked & Ordered Very little or no impact, not worth the effort. Have an impact, but would not meet by their single location. Any single provider at one of these locations would provide access to 90% of membership. 19. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 VALIDATING THE DATA 20. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 CASE STUDY: New Market Expansion 21. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 CASE STUDY Two Identified markets to enter Prioritized counties within markets Purchased lists within expansion areas Or Use The: Leveraged Narrow Network to rank & order NEW MARKET EXPANSION 22. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 MEASURING IMPACT Across Counties Name Cottonwood Faribault Fillmore Freeborn Martin Mower Nobles Olmsted Redwood Stevens Swift Winona Yellow Medicine Counties Impacted Counties Meeting Criteria Claude Deschamps 96.5% 100.0% 100.0% 100.0% 99.3% 100.0% 0.0% 100.0% 23.1% 0.0% 0.0% 0.0% 0.0% 8 7 Francis Nichols 96.5% 100.0% 100.0% 100.0% 99.3% 100.0% 0.0% 100.0% 23.1% 0.0% 0.0% 0.0% 0.0% 8 7 Harold Burkhart 96.5% 100.0% 100.0% 100.0% 99.3% 100.0% 0.0% 100.0% 23.1% 0.0% 0.0% 0.0% 0.0% 8 7 K Shen 96.5% 100.0% 100.0% 100.0% 99.3% 100.0% 0.0% 100.0% 23.1% 0.0% 0.0% 0.0% 0.0% 8 7 Lucian Durham 96.5% 100.0% 100.0% 100.0% 99.3% 100.0% 0.0% 100.0% 23.1% 0.0% 0.0% 0.0% 0.0% 8 7 Mark Allen 96.5% 100.0% 100.0% 100.0% 99.3% 100.0% 0.0% 100.0% 23.1% 0.0% 0.0% 0.0% 0.0% 8 7 Stephen Cassivi 96.5% 100.0% 100.0% 100.0% 99.3% 100.0% 0.0% 100.0% 23.1% 0.0% 0.0% 0.0% 0.0% 8 7 Abinash Virk 0.0% 100.0% 100.0% 0.0% 100.0% 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% 100.0% 0.0% 6 6 Alan Wright 0.0% 100.0% 100.0% 0.0% 100.0% 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% 100.0% 0.0% 6 6 Andrew Badley 0.0% 100.0% 100.0% 0.0% 100.0% 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% 100.0% 0.0% 6 6 Bradley Thaemert 100.0% 0.0% 0.0% 0.0% 33.3% 0.0% 0.0% 0.0% 0.0% 100.0% 100.0% 0.0% 100.0% 5 4 Francis Buadi 0.0% 0.0% 0.0% 0.0% 0.0% 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% 0.0% 0.0% 2 2 Franciscan Skemp La Crosse Hsptl 0.0% 0.0% 100.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 1 1 Eduardo Benarroch 0.0% 0.0% 0.0% 0.0% 0.0% 100.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 1 1 Frazier Eales 0.0% 47.2% 0.0% 89.4% 1.3% 0.0% 0.0% 0.0% 35.2% 0.0% 0.0% 0.0% 0.0% 4 0 Thomas Flavin 0.0% 47.2% 0.0% 89.4% 1.3% 0.0% 0.0% 0.0% 35.2% 0.0% 0.0% 0.0% 0.0% 4 0 Timothy Kroshus 0.0% 47.2% 0.0% 89.4% 1.3% 0.0% 0.0% 0.0% 35.2% 0.0% 0.0% 0.0% 0.0% 4 0 Ashlee Tackmann 0.0% 0.0% 0.0% 0.0% 0.0% 17.9% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 1 0 Blake Gillette 0.0% 0.0% 0.0% 0.0% 0.0% 17.9% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 1 0 Carl Bechtold 0.0% 0.0% 0.0% 0.0% 0.0% 17.9% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 1 0 Douglas Pay 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 89.7% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 1 0 Christopher Heck 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 21.3% 0.0% 0.0% 0.0% 0.0% 1 0 Targeted Recruitment List Across Counties 23. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 MEASURING IMPACT OF A LOCATION(S) 24. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 INCORPORATE UTILIZATION/COST/QUALITY 25. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 CASE STUDY: Right Sizing the Network 26. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 HEALTHCARE EXCHANGE ASSESSMENT Existing network limited by quality & cost Goal to minimize risk of HIX participation Still maintaining network adequacy requirements Determine minimum required targets Narrow Network to identify minimums 27. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 RANKING BY QUALITY/COST 28. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Data EXTRACTION STARTED WITH ENDED WITH HOSPITALS HOSPITALS 29. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 NARROW NETWORK VALIDATION Validation the Narrow Network to the Broad Network Success! Excellent Access with a Limited Network 30. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 A Pharmacy Success Story! 31. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 1. Takes existing network and ranks providers based on impact to members covered in each geographic area 2. Focuses on minimum number of providers to meet criteria 3. Checks adequacy after each provider to determine next best 4. Allows carrier to meet network adequacy requirements, but minimize risk of including full network 5. Provides incentives for provider participation 6. Incorporates cost and quality variables A NEW MODEL EXPLODES 32. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Market Opportunity and Return on Expansion Following the Money 33. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Revenue Stream 2014 HSD Reference File 2014 Reimbursement Rates 34. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Determining The Effort 35. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 How Much Is Effort Worth? 36. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 THANK YOU VERY MUCH! Darren Huff Regional Sales Director East Region [email protected] Linda Borths Director of Sales [email protected] John Weis President & Co-Founder [email protected] Robert Smith Regional Sales Director West Region [email protected]