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Learning & Informatics Summit
2017Adventures in Accuracy: State of the Industry in the Quest for a Clean Network
Session 2
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Learning & Informatics Summit
2017One Year Later…
Part 1
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YOY Improvements in California Directory Samples
Next steps in Quality Improvement…
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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%.
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Audience Poll
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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
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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
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Learning & Informatics Summit
2017Workforce Trends and impact update…
Part 2
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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%
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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.”
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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.”
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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
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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
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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
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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
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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™
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Dentists per Location
Affiliated Group Practices
Average 8 dentists per Group
2.5 dentists per location
Unaffiliated Group Practices
Average 4 dentists per Group
1.6 dentists per location
Individual Practices
Average 1.5 dentists
1.5 dentists per location
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Affiliated Group Practices – National
Affiliated Group Practices can be found in all major metropolitan areas
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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
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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.
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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.
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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.
Average # of providers per location = 2.9
93% of the dentists are GPs.
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.
Average # of providers per location = 4.9
78% of the dentists are GPs.
Largest # of Locations Most States Largest # of Dentists
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What type of dentists are at these locations?
98% - GPs
<1% - PDs
2% - Other Specialists
93% - GPs
0% - PDs
7% - Other Specialists
78% - GPs
6% - PDs
16% - Other Specialists
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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
290+ locationsOperate under multiple
brands.Average # of providers per location = 2.3
Great Expressions Dental Care Services
250+ locationsOperate under multiple
brands.Average # of providers per location = 2.1
Affordable Care/ Affordable Dentures
250+ locationsOperate under
common branding.Average # of
providers per location = 1.5
Dental Care Alliance
220+ locationsOperate under multiple
brands.Average # of providers per location = 3.0
Western Dental/Brident
Dental
200+ locationsOperate under
common branding –Western Dental & Brident Dental & Orthodontics.
Average # of providers per location = 4.2
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Coming Soon -
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Learning & Informatics Summit
2017P&R Dental Strategies Unique Insight
Part 4
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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
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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
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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
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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
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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
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Introducing Confidence Levels
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Audience Poll
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Audience Poll
How important is visibility of low confidence access points?
• Not important• Somewhat important• Very important• Extremely important
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