Adventuresin+ Accuracy:Stateofthe+ 2017 IndustryintheQuest … · Session2....

Confidential and Proprietary

Learning & Informatics Summit 2017

Learning & Informatics Summit

2017Adventures in Accuracy: State of the Industry in the Quest for a Clean Network

Session 2




2017One Year Later…

Part 1



YOY Improvements in California Directory Samples

Next steps in Quality Improvement…



Sample National View - % Confirmed Active

Sample Payer Directory– The highest state’s % of confirmed active access points is 60%

to 80%. The lowest is less than 20%.



Audience Poll



Audience Poll

How do you currently identify accuracy issues with your directory?

• Reports by plan users• Regular internal review• Outside consultant review• We currently have no system in place to find and remove inaccurate access points• Other



Audience Poll

How do you feel about the current status of your directory?

• Optimized: More access points and fewer inactive access points

• Accurate…but fewer access points• Needs more work




2017Workforce Trends and impact update…

Part 2



Directory Accuracy – Keeping Up with MovementUpdate: April 2016 – March 2017

63%*Occurred in Group Practices

37%*Occurred in Solo Practices

Of those that changed location…

*Source: P&R Dental Strategies DentaBase™ - Rolling one year period, May 2015 – May 2016

of the dentists changed location at least once during the year

35.2%34.4%*

43.1% 56.9%



2013

Critical Trends Affecting the Future of Dentistry: Assessing the Shifting Landscape, Prepared for the ADA, Diringer Associates May 2013

“The trend towards larger, multi-site practices will continue to be driven by dental plan pressures for smaller provider networks, practice patterns of new dentists and increased competition for patients.”



June 2017

Michael W. Davis, DDS “Storm Clouds on the Horizon for DSOs.” Dental Economics. Macro & OpEd. June 2017

“The growth phase of the DSO industry may be starting to plateau, perhaps in a transition to a mature phase… there appear to be a few notable storm clouds on the horizon.

Industry shakeups are inevitable, and the ride will be bumpier for some more than others. Large private equity firms may be best positioned to weather any storm that strikes the DSO industry.”



Landscape - 2004 to 2016

2004~180,000 actively practicing dentists

76% of practicing

dentists are in solo practice

Women make up

about 19% of US dentists

Average age of Dentist is 50

Source: American Dental Association, 2008

2016 View

~194,000 actively practicing dentists

86% of active dentists are practicing

in unaffiliated individual practices

Women make up about 25%of active US dentists

Average age of Dentist is 50Source: ADA



Single site vs. Multi-site Practices?

80% of the Dental Practice Locations continue to be unaffiliated single location practices

~ 125,000U.S. Locations

*As of 5.31.2017



Affiliated Group Practices

5% of the Dental Practice Locations are Identified to be Affiliated with Large Groups

10% of the Active Dentists are Identified to be Affiliated with Large Groups

Affiliated Group Practices are part of a group under an umbrella organization or brand that does not necessarily share same practice name or tax IDs across locations. Examples are DSO and VA.

~ 7,500 U.S. Locations

~ 18,500 Dentists



Individual Practices (Unaffiliated)

95% of the Dental Practice Locations are not identified to be part of an Affiliated large group

90% of the Active Dentists are practicing at Unaffiliated Locations

Unaffiliated Practices are not associated with a larger umbrella organization or brand.

~ 148,000 U.S. Locations

~ 165,000 Dentists



Trend toward Multi-Provider Locations

From DentaBase™ – From 2013 to 2016 – more than 2/3rds of the claims are from practices with more than one dentist treating at the location.

DOS Year

Percent ofDentaBase™ Claims from locations with

more than one treating dentist

Percent of DentaBase™ Claimsfrom locations with one treating dentist

2013 79.2% 20.8%2014 78.8% 21.2%2015 83.8% 16.2%2016 79.4% 20.6%

*Source: P&R Dental Strategies DentaBase™



Dentists per Location

Affiliated Group Practices

Average 8 dentists per Group

2.5 dentists per location

Unaffiliated Group Practices

Average 4 dentists per Group


Individual Practices

Average 1.5 dentists




Affiliated Group Practices – National

Affiliated Group Practices can be found in all major metropolitan areas



Affiliated Group Practices – Los Angeles to NYC

However there are geographic differences. For example, there are many more affiliated Group Practices in southern California vs. the NYC metro area.

Los Angeles NYC



Practice Focus: Specialty?

Primary Care95% of the Affiliated

Locations

87% of the Independent (UnaffiliatedLocations)

Specialty5% of the Affiliated

Locations

13% of the Independent

(Unaffiliated Locations)

Primary Care is any location where at least one General Dentist and/or Pediatric Dentist is affiliated.

Specialty is any location where only other specialists (Endodontists, Oral Surgeons, Orthodontists, Periodontists) are affiliated.



Overview of Identified Affiliated Dental Groups

500or MoreLocations

200 - 499 Locations

100 - 199 Locations

50 - 99 Locations

3AffiliatedDental Groups

AffiliatedDental Groups7

AffiliatedDental Groups6AffiliatedDental Groups

3

Where are most of the new affiliations identified?

• 20 to 49 locations: 15 affiliated right now

• 5 to 19 locations: 20+ affiliated right now

• 4 locations: 11+ affiliated right now

• 3 or fewer:A lot.



Affiliated Groups with >500 locations

780+ locationsAt least one location in: AL, AR, AZ, CA, CT, FL, GA, IA, IL, IN, KS, KY, LA, MA, MD, MI, MO, MS, NC, NE, NH, NM, NV, NY, OH, OK, PA, SC, TN, TX, VA, WI, WV

50% of locations are in FL, IL,IN, TX, MO, and OK

Operate under multiple brands.

Average # of providers per location = 1.6

98% of the dentists are GPs.

600+ locationsAt least one location in: AL, AR, AZ, CO, CT, FL, GA, IA, ID, IL, IN, KY, MA, MD, ME, MI, MN, MO, ND, NJ, NY, OK, OH, OR, PA, RI, SC, SD, TN, TX, NE, NH,

VT, WA, WI, and WV 50% of locations are in FL, NY,

OH, PA, IN, and MA

Operate under common branding.



500+ locationsAt least one location in: AZ, CA, CO, GA, ID, KS, MA, MN, MO, NM, NV, NY, OR,

TX, UT, and WA. Almost 50% of the locations

are in CA.

Operate under multiple brands.



Largest # of Locations Most States Largest # of Dentists



What type of dentists are at these locations?

98% - GPs

<1% - PDs

2% - Other Specialists

93% - GPs

0% - PDs


78% - GPs

6% - PDs




Rounding out the Top 10 - Affiliated Groups with 200 to 499 locations

SmileBrands, Inc.

375+ locationsOperate under multiple

brands.Average # of providers per location = 2.3

InterDent

375+ locationsOperate under

common branding.Average # of providers per location = 2.4

American Dental Partners



Great Expressions Dental Care Services



Affordable Care/ Affordable Dentures


common branding.Average # of

providers per location = 1.5

Dental Care Alliance



Western Dental/Brident

Dental


common branding –Western Dental & Brident Dental & Orthodontics.




Coming Soon -




2017P&R Dental Strategies Unique Insight

Part 4



P&R Dental Strategies Workflow

P&R Dental StrategiesAccessPoints

Data Transformation

Process

Data Transformation

Process

• From 3rd party credentialing source(s)

• From NPI database• From claims data

PROVIDER

• From 3rd party credentialing source

• From claims data

ADDRESS

ProviderMaster

AddressMaster



Leveraging Resources –Identify and keep up with the moving targets

Result: Prioritizes Resource Allocation to tackle the next steps

Utilizes 3rd party credentialing sources

1 Insights to claims by location in the database

2

Claims paid in last 30 days from any payer

3

Network Accuracy



Address Cleansing & Matching• Addresses from each Source are Standardized & Cleansed to build our Address Master using the following techniques1. A trusted third party credential source is used to standardize the

address.• 76 Northeast Blvd• 76 NE Blvd• 76 North East Boulevard

2. Latitude / Longitude “Rooftop” cross verification is done with Bing Maps to improve accuracy.

3. High Similarity & Confidence Score fuzzy match algorithms are used to obtain an Address Score for an accurate match

4. A small percentage of Records that are unmatched are Manually Verified and Validated

5. A high level quality control is done on our Address Master to Assure Reliability and Integrity of Algorithms



Provider Matching & Cleansing• Provider data is received from Multiple Sources • Providers are matched and cleansed using following techniques • Matching Algorithm is built on the key entities like Name, License and NPI to get precise matching

• Ranking factor is applied across different sources using a weightage algorithm.

• Algorithm runs deep to differentiate between a JR / SR and a Group / Individual NPI.

• High Similarity & Confidence Score fuzzy match algorithms are used to obtain a Provider Score for an accurate match.

• Any Entity that is missing from the 3rd Party source (or) NPI source like Middle Name, Phone, Title, etc. are completed using the claims source using a Ranking factor.

• High Level Quality control is done to maintain the validity of the Provider data



Establishing the Access Point(s)

• Access Point • An Unique Provider and an Address Combination is defined as Access Point

• Unique Suite Numbers at the same Street Address is a Unique Address (Access Point)

• An access point is also matched to a practice name / Tax-ID Provider Access Point establishes Service Location(s)

• Providers to Access Point is a Many to Many Relationship• Provider can practice at multiple Service Locations• Service Locations can have multiple Providers

• To determine the ACTIVE / CONFIRMED status of an access point:• Confirmed by the 3rd Party Credentialing;; or• Confirmed if there is a claim submission across any 3 payers in the last 60 days of claims data



Introducing Confidence Levels



Audience Poll



Audience Poll

How important is visibility of low confidence access points?

• Not important• Somewhat important• Very important• Extremely important

Adventuresin+ Accuracy:Stateofthe+ 2017 IndustryintheQuest … · Session2....

Documents

Transcript of Adventuresin+ Accuracy:Stateofthe+ 2017 IndustryintheQuest … · Session2....