By Tim Fitzgerald on Jul 13, 2020 3:00:00 PM
One of the most important things for employers to keep in mind when switching insurance carriers is the network. Every employer wants to make sure their employees have access to providers, but they also want to make sure the providers their employees are already using will be in their new network. It can be a real headache when upset employees find out their longtime dentist isn’t in network anymore - that's where disruption reports come in. Disruption reports can prevent this problem by letting you know ahead of time which of the group’s most utilized providers each prospective carrier has. Here are some frequently asked questions about disruption reports and some insights that can help you find the best carriers for your clients.
What is a disruption report?
According to NetMinder, a disruption report is a method of network analysis that “correlates historical provider utilization and claims experience for a group of employees to the providers in a different network.” Brokers use disruption reports to measure which carriers have most of the providers an employee group uses. A carrier can have a great network, but if every employee has to find a new dentist to get coverage - they are going to have a negative experience. The disruption report is a list of the most utilized providers (sent by the broker and the employer group), which the carrier cross references with their networks to determine how many employees will have their care disrupted by changing networks. If you want a more in-depth look at disruption reports, you can download Netminder’s whitepaper on disruption reports here.
How are the top utilized providers identified?
The simplest way to identify a group’s top providers is to look at their claims history. The providers with the most claims will be your top utilized providers list. It is that easy! However, if your client is looking for a more specific provider listing, you can also look at which providers treated the highest number of patients, preformed the most procedures, or had the most paid claims.
How do you best evaluate disruption reports?
The basics of evaluating a disruption report is simple – just identify which carriers have the most top-utilized providers in their networks. But analyzing disruption reports can be a little trickier than that. Here are a few relevant tips to analyzing disruption reports:
- Think about any proposed network discounts – in-network discounts aren’t a selling point if most employees’ providers are out-of-network.
- Keep geography in mind – highly utilized providers in rural areas are especially important. There might not be many alternatives for employees in a rural area.
- Be aware of the network structure – is this an HMO or PPO network? The disruption may be more important for employees who select the HMO, since they don’t have the option to see a provider out-of-network and still be covered.
With a little preparation and knowing what to look for, disruption reports can be a useful tool. They’re straightforward and an easy way to get the network information you need and help your clients make the right decisions. To learn more about network analysis, check out our blog post on Network Access Reports and download our free disruption reports guide by clicking on the image below.