4.3 Network Analysis
See Also: Benefit / Network Analysis and Provider Analysis include additional information related to network utilization and discount performance.
The Network Utilization Analysis is used to determine how network contracts (and other discount outlets) are being utilized by the covered population, how payment is distributed between plan and member, as well as the real discount rate being received.
The top half of the report (above) shows how total billed charges are distributed between plan sponsor, member, and savings for both in and out of network charges. Please note that "Other" consists of Ineligible and COB charges.
The Network Breakout (below) shows the individual Preferred Provider Organizations (PPOs), other discount outlets and COB along with information on discount performance and usage. Note that clicking on a specific network category drills down into that item.
The following fields are included in the Network Breakout:
- Claim Count: The number of claims; useful in determining the volume of activity.
- Total Charge: Original total amount billed by provider before network discount or other types of savings are applied. More.
- Discount: Amount of savings from PPO and other discount outlets. More.
- Savings Percentage: The "discount rate" (percentage of total charge reduction through savings).
- Plan Paid: Total amount paid by plan sponsor.
- Percentage of Usage: The percentage of total dollars paid by the plan sponsor. More.
TIP: For most plans, 80% or more of the percentage of usage should be going through network contracts. If less than 80% of usage is in network, you may want to consider employing network steerage techniques to increase network utilization.