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NBC National Network Initiative: Update and Discussion San Diego September, 2007

NBC National Network Initiative: Update and Discussion San Diego September, 2007. Contributing Organizations. Total Count of Providers in the NBC Network. NBC NATIONAL NETWORK. Count of Facilities by State.

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NBC National Network Initiative: Update and Discussion San Diego September, 2007

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  1. NBC National Network Initiative:Update and DiscussionSan DiegoSeptember, 2007

  2. Contributing Organizations

  3. Total Count of Providers in the NBC Network

  4. NBC NATIONAL NETWORK

  5. Count of Facilities by State * We are doing further research to identify how many reported facilities are inpatient or residential units vs. outpatient services.

  6. Count of Providers by State

  7. Count of Providers by State

  8. Ranges and Mean of NBC Fees by CPT Code

  9. Definitions • “Contributing Members” are NBC Members (or associated non-NBC members) who agree to the use of their provider network to create a national network • “Participating Members” are NBC Members who use the NBC network under terms and conditions established by NBC’s Contributing Members

  10. Questions & Issues for DiscussionContractual • How does NBC best protect the interests of Contributing Members? • Non-solicitation • Competitive issues • Confidentiality • Does the Contributing Member’s provider contract allow for network rental? If not, what are the options? • Amending existing contracts that don’t allow for network rental • Other options • What kinds of contracts are needed between Contributing and Participating Members to support an NBC Network? • Create a network of inter-Member agreements • Develop a single Member-NBC network usage agreement

  11. Questions & Issues for DiscussionOperational • How do we establish a single source (master provider file) for the network? • NBC out sources to a “neutral” vendor and share the costs • NBC out sources to an NBC member company and shares the costs (should be minimal) • How is the NBC network maintained? • Updates by each Contributing Member to NBC on a quarterly basis • Who handles what kinds of provider issues? • Problems with a provider – Contributing or Participating Member? • Problems with claims/authorizations – Participating Member

  12. Questions & Issues for DiscussionOperational • We will need to create a standardized set of definitions so that we can accurately describe the network • How do we show specializations for outpatient providers and facilities? • How do we insure compliance to accreditation standards for credentialing? • Each Participating Member must load the network and associated rates into their own claims payment system from the master provider file

  13. Questions and Issues for DiscussionFinancial • Who gets paid for what and how much? • ASO rates are around 0.70 PMPM to 1.00 PMPM • Even 0.10 PMPM will make any of us non-competitive on price • Contributing to the network involves minimal cost while significantly expanding opportunities for revenue • Whatever we charge for our networks will be charged back to us by others

  14. Turning Gold into Lead • Excessive legal review and risk management • Charging too much for network rental • Over thinking legal and operational issues

  15. QUESTIONS?Level of interest?Where do we go from here?Next steps?

  16. Count of Providers by Discipline and State

  17. Count of Providers by Discipline and State

  18. Count of Providers by Discipline and State

  19. Count of Providers by Discipline and State

  20. Count of Providers by Discipline and State

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