nbc national network initiative: update and discussion san diego september, 2007
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
NBC National Network NBC National Network Initiative:Initiative:
Update and DiscussionUpdate and Discussion
San DiegoSan DiegoSeptember, 2007September, 2007
Contributing OrganizationsContributing Organizations
PsychiatristsPsychiatristsDoctorate Doctorate
Level Level PsychologistsPsychologists
Masters Level Masters Level CliniciansClinicians
Clinical Nurse Clinical Nurse SpecialistsSpecialists TotalTotal
4,3614,361 4,0284,028 13,87713,877 2,4872,487 24,75324,753
Total Count of Providers in the NBC Total Count of Providers in the NBC NetworkNetwork
NBC NATIONAL NETWORK
STATESTATE FACILITY FACILITY COUNTCOUNT
STATESTATE FACILITY FACILITY COUNTCOUNT
ArkansasArkansas 1313 North DakotaNorth Dakota 55
CaliforniaCalifornia 99 NebraskaNebraska 99
ColoradoColorado 22 New JerseyNew Jersey 22
FloridaFlorida 22 New YorkNew York 55
GeorgiaGeorgia 44 OhioOhio 1515
IowaIowa 1010 OklahomaOklahoma 66
IllinoisIllinois 76*76* OregonOregon 55
IndianaIndiana 1212 PennsylvaniaPennsylvania 99
KansasKansas 88 Rhode IslandRhode Island 22
LouisianaLouisiana 88 South DakotaSouth Dakota 22
MassachusettsMassachusetts 33 TennesseeTennessee 1212
MichiganMichigan 11 TexasTexas 1010
MinnesotaMinnesota 23*23* VirginiaVirginia 22
MissouriMissouri 1010 WashingtonWashington 44
MississippiMississippi 11 WisconsinWisconsin 1313
North CarolinaNorth Carolina 50*50*
TOTALTOTAL 333333
* We are doing further research to identify how many reported facilities are inpatient or residential units vs. outpatient services.
Count of Facilities by State
StateState TotalTotal StateState TotalTotal StateState TotalTotal
AKAK 22 DEDE 77 KYKY 117117
ALAL 797797 FLFL 5,9115,911 LALA 195195
ARAR 119119 GAGA 246246 MAMA 161161
AZAZ 681681 HIHI 7 7 MDMD 179179
CACA 2,7882,788 IAIA 290290 MEME 2222
CNCN 11 IDID 250250 MIMI 101101
COCO 151151 ILIL 911911 MNMN 148148
CTCT 4949 ININ 137137 MOMO 1,5611,561
DCDC 1111 KSKS 1,1481,148 MSMS 5050
Count of Providers by Count of Providers by StateState
StateState TotalTotal StateState TotalTotal StateState TotalTotal
MTMT 1818 OHOH 635635 TXTX 1,0161,016
NCNC 1,8171,817 OKOK 104104 UTUT 134134
NDND 6464 VAVA 192192
NENE 128128 OROR 867867 VTVT 66
NHNH 2828 PAPA 184184 WAWA 285285
NJNJ 144144 RIRI 1010 WIWI 129129
NMNM 1,0631,063 SCSC 1,2951,295 WVWV 4040
NVNV 1616 SDSD 2424 WYWY 2929
NYNY 226226 TNTN 220220 TOTALTOTAL
24,7124,7144
Count of Providers by Count of Providers by StateState
DisciplineDiscipline CPT CodeCPT Code
9080190801CPT CodeCPT Code
9080690806CPT CodeCPT Code
9086290862CPT CodeCPT Code
9923399233
PsychiatristPsychiatrist $65-$234$65-$234
Mean of $123Mean of $123N/AN/A $45-$80$45-$80
Mean of $58Mean of $58
$65-$128$65-$128
Mean of $89Mean of $89
Doctorate Doctorate Level Level PsychologistPsychologist
$60-$182$60-$182
Mean of $91Mean of $91$60-$85$60-$85
Mean of $76Mean of $76N/AN/A N/AN/A
Masters Level Masters Level ClinicianClinician
$55-$134$55-$134
Mean of $80Mean of $80$55-$86$55-$86
Mean of $67Mean of $67N/AN/A N/AN/A
Clinical Nurse Clinical Nurse SpecialistSpecialist
$55-$150$55-$150
Mean of $105Mean of $105$55-$125$55-$125
Mean of $66Mean of $66$30-$117$30-$117
Mean of $66Mean of $66N/AN/A
Ranges and Mean of NBC Fees by CPT CodeRanges and Mean of NBC Fees by CPT Code
DefinitionsDefinitions
► ““Contributing Members” are NBC Members (or associated Contributing Members” are NBC Members (or associated non-NBC members) who agree to the use of their provider non-NBC members) who agree to the use of their provider network to create a national networknetwork to create a national network
► ““Participating Members” are NBC Members who use the NBC Participating Members” are NBC Members who use the NBC
network under terms and conditions established by NBC’s network under terms and conditions established by NBC’s Contributing MembersContributing Members
Questions & Issues for DiscussionQuestions & Issues for Discussion
ContractualContractual
► How does NBC best protect the interests of How does NBC best protect the interests of Contributing Members?Contributing Members? Non-solicitationNon-solicitation Competitive issuesCompetitive issues ConfidentialityConfidentiality
► Does the Contributing Member’s provider contract Does the Contributing Member’s provider contract allow for network rental?allow for network rental?If not, what are the options?If not, what are the options? Amending existing contracts that don’t allow for network rentalAmending existing contracts that don’t allow for network rental Other optionsOther options
► What kinds of contracts are needed between What kinds of contracts are needed between Contributing and Participating Members to support an Contributing and Participating Members to support an NBC Network?NBC Network? Create a network of inter-Member agreements Create a network of inter-Member agreements Develop a single Member-NBC network usage agreementDevelop a single Member-NBC network usage agreement
Questions & Issues for DiscussionQuestions & Issues for Discussion
OperationalOperational
► How do we establish a single source (master provider How do we establish a single source (master provider file) for the network?file) for the network? NBC out sources to a “neutral” vendor and share the costsNBC out sources to a “neutral” vendor and share the costs NBC out sources to an NBC member company and shares the NBC out sources to an NBC member company and shares the
costs (should be minimal)costs (should be minimal)
► How is the NBC network maintained?How is the NBC network maintained? Updates by each Contributing Member to NBC on a quarterly Updates by each Contributing Member to NBC on a quarterly
basisbasis
► Who handles what kinds of provider issues?Who handles what kinds of provider issues? Problems with a provider – Contributing or Participating Member?Problems with a provider – Contributing or Participating Member? Problems with claims/authorizations – Participating MemberProblems with claims/authorizations – Participating Member
Questions & Issues for DiscussionQuestions & Issues for Discussion
OperationalOperational
► We will need to create a standardized set of definitions We will need to create a standardized set of definitions so that we can accurately describe the networkso that we can accurately describe the network
► How do we show specializations for outpatient How do we show specializations for outpatient providers and facilities?providers and facilities?
► How do we insure compliance to accreditation How do we insure compliance to accreditation standards for credentialing?standards for credentialing?
► Each Participating Member must load the network and Each Participating Member must load the network and associated rates into their own claims payment system associated rates into their own claims payment system from the master provider filefrom the master provider file
Questions and Issues for DiscussionQuestions and Issues for Discussion
FinancialFinancial
► Who gets paid for what and how much?Who gets paid for what and how much?
ASO rates are around 0.70 PMPM to 1.00 PMPM ASO rates are around 0.70 PMPM to 1.00 PMPM Even 0.10 PMPM will make any of us non-competitive on priceEven 0.10 PMPM will make any of us non-competitive on price
► Contributing to the network involves minimal cost Contributing to the network involves minimal cost while significantly expanding opportunities for revenuewhile significantly expanding opportunities for revenue
Whatever we charge for our networks will be charged back to us Whatever we charge for our networks will be charged back to us by othersby others
Turning Gold into LeadTurning Gold into Lead
► Excessive legal review and risk management Excessive legal review and risk management
► Charging too much for network rentalCharging too much for network rental
► Over thinking legal and operational issuesOver thinking legal and operational issues
QUESTIONS?QUESTIONS?
Level of interest?Level of interest?
Where do we go from here?Where do we go from here?Next steps?Next steps?
StateState PsychiatristPsychiatrist Ph.D. Ph.D. PsychologistPsychologist
Masters Level Masters Level ClinicianClinician
CNS/ARNPCNS/ARNP TotalTotal
AKAK 00 00 22 00 22
ALAL 162162 194194 441441 00 797797
ARAR 1414 1515 909909 00 119119
AZAZ 8383 127127 443443 2828 681681
CACA 371371 625625 17881788 44 27882788
CNCN 00 00 11 00 11
COCO 11 2121 129129 00 151151
CTCT 00 77 4242 00 4949
DCDC 11 22 88 00 1111
DEDE 00 11 66 00 77
FLFL 18341834 595595 12041204 22782278 59115911
GAGA 2222 3737 187187 00 246246
Count of Providers by Discipline and State
Count of Providers by Discipline and State
StateState PsychiatristPsychiatrist Ph.D. Ph.D. PsychologistPsychologist
Masters Level Masters Level ClinicianClinician
CNS/CNS/
ARNPARNPTotalTotal
HIHI 00 33 44 00 77
IAIA 3333 5454 203203 00 290290
IDID 1111 5757 179179 33 250250
ILIL 9898 110110 703703 00 911911
ININ 1313 2727 9797 00 137137
KSKS 186186 203203 759759 00 11481148
KYKY 1616 1515 8080 66 117117
LALA 2727 2424 144144 00 195195
MAMA 1212 3737 112112 00 161161
MDMD 44 2323 152152 00 179179
MEME 00 44 1818 00 2222
StateState PsychiatristPsychiatrist Ph.D. PsychologistPh.D. Psychologist Masters Level Masters Level ClinicianClinician
CNS/ARNPCNS/ARNP TotalTotal
MIMI 44 1919 7878 00 101101
MNMN 1010 3333 105105 00 148148
MOMO 278278 260260 10231023 00 15611561
MSMS 11 66 4141 22 5050
MTMT 00 44 1414 00 1818
NCNC 363363 360360 10661066 2828 18171817
NDND 1616 1313 3535 00 6464
NENE 1616 3030 8282 00 128128
NHNH 00 88 2020 00 2828
NJNJ 1313 1717 114114 00 144144
NMNM 113113 183183 729729 3838 10631063
NVNV 11 33 1212 00 1616
NYNY 66 3535 185185 00 226226
OHOH 147147 4545 424424 1919 635635
Count of Providers by Discipline and State
Count of Providers by Discipline and State
StateState PsychiatristPsychiatrist Ph.D. PsychologistPh.D. Psychologist Masters Level Masters Level ClinicianClinician
CNS/CNS/
ARNPARNPTotalTotal
OKOK 44 2222 7878 00 104104
ONON 00 11 2323 00 2424
OROR 140140 276276 402402 4949 867867
PAPA 66 2626 152152 00 184184
RIRI 11 00 99 00 1010
SCSC 196196 164164 917917 1818 12951295
SDSD 33 11 2020 00 2424
TNTN 4343 3737 140140 00 220220
StateState PsychiatristPsychiatrist Ph.D. Ph.D. PsychologistPsychologist
Masters Level Masters Level ClinicianClinician
CNS/CNS/
ARNPARNPTotalTotal
TXTX 7474 148148 792792 22 10161016
UTUT 33 3030 100100 11 134134
VAVA 66 1414 172172 00 192192
VTVT 22 11 33 00 66
WAWA 1010 6262 203203 1010 285285
WIWI 1515 4141 7373 00 129129
WVWV 22 44 3434 00 4040
WYWY 00 44 2525 00 2929
AB-AB-CANADACANADA
00 00 22 00 22
BC-BC-CANADACANADA
00 00 11 11 22
QC-QC-CANADACANADA
00 00 11 00 11
QU-QU-CANADACANADA
00 00 33 00 33
SK-SK-CANADACANADA
00 00 77 00 77
TOTALTOTAL 436436 40284028 1387713877 24872487 2475324753
Count of Providers by Discipline and State