IntellimedIntellimed

By Ed Willard

Insights from The Healthcare Marketing & Physician Strategies Summit

Insights from The Healthcare Marketing & Physician Strategies Summit

INTELLIMED was both an exhibitor and participant at this month’s 22nd Annual Healthcare Marketing & Physician Strategies Summit on May 8-10, 2017 in Austin presented by The Forum for Healthcare Strategists. The Summit is for senior-level healthcare marketing, strategy, physician relations, sales and business development executives from hospitals, health systems, academic medical centers, integrated networks and medical groups.

After the event, our team got together and compared notes on the event. Here are the key themes and insights we heard:

  • Reputation Management – With 84% of patients trusting online reviews the same as a personal recommendation and 47% of patients saying they would go out of network to a doctor with better reviews, online reviews matter and are on hospital’s radars. Doctors are also complaining about negative reviews and demanding hospitals do something about them. Having data and insights around online reviews about their physicians and facility is an area of increasing interest to hospitals and health systems.
  • Mergers & Acquisitions, Convenience Clinics and Brand Cohesion – With continued activity in mergers and acquisitions, rebranding continues to be a challenge as systems struggle to create a cohesive brand across their various facilities. Health systems are also seeking to create more outpatient sites – notably “convenience care” clinics with similar models to Walgreens and CVS. A challenge with such expansion is placing these facilities in locations that complement rather than compete with primary care physicians in their system. Having strong partnerships with local physicians will be critical to successful placement and business for these convenience care facilities.
  • Healthcare Consumerism and the Patient Experience – Momentum for the patient experience continues to grow with the rise of healthcare consumerism. Leveraging marketing strategies in the areas of advertising, social media and online marketing geared toward branding and patient experience are being seen across more healthcare systems. Healthcare has not typically been focus on the consumer brand experience and this is changing.
physician leakage, outward migration, healthcare data analytics, big data healthcare

By Ed Willard

Physician Leakage & Using Data to Prevent Outward Migration

Physician Leakage & Using Data to Prevent Outward Migration

Physician referrals are a link between primary and specialty care and are vital to patient management and volume within a healthcare system. In fact, visits to specialists constitute more than half of outpatient physician visits in the United States. Physician leakage refers to the process of physicians referring patients to competing hospitals or providers outside of their network.

A recent article Dropping the Baton: Specialty Referrals in the United States notes the following breakdowns and inefficiencies in all components of the specialty-referral process:

Outward migration affects both patient care and a hospital’s bottom line:

  • Reduced continuity of care
  • Delays in diagnosis and treatment
  • Duplication of services and testing wasting hospital resources
  • The simultaneous use of multiple drugs to treat a single ailment or condition, or polypharmacy
  • Increased risk of malpractice lawsuits
  • Weakened physician-patient relationships

Physician Leakage and Outward Migration

Looking more closely at the financial impact of outward migration, let’s look at this example provided by Lance Fusacchia in an HFMA article:

“Consider for a moment the potential financial losses of referral no-shows in terms of actual dollars. As an example, a typical healthcare system with 200 providers, each serving a panel of 2,000 patients. Of those 400,000 patients, it is fair to estimate that 50 percent visit their physicians and 30 percent of those visits result in a referral. That makes 60,000 potential referral visits. If 30 percent of those referrals don’t happen (the average number of no-shows, as cited previously), that’s approximately 18,000 lost referrals. According to findings in one study, a single no-show costs a provider, on average, $210. Multiplying that amount by 18,000 no-shows results in $3.78 million in lost revenue. If a health system could avert even 25 percent of those lost referrals, it could recover nearly $1 million in lost revenue.”  

The Role of Data in Preventing Outward Migration

Data plays a major role in the prevention of outward migration. Having data alone, however, won’t solve the challenges. Being able to have the data analytics tools to gain key insights from the data will provide the needed information to adjust physician referral management programs and processes.

  • Comparing Past to Present Data – Historical data can allow for a view of events that may be factoring into lost business. A referral drop is a cause for concern to be investigated and resolved.
  • High-Tail & Long-Tail – These are common terms in marketing and should be applied to outward migration data analytics. Basically, high-tail means that 80% of monitored events occur in the first 20% of a population metric. Low-tail comprises the remaining 20% of monitored events, but it can often outweigh the overall high-tail impact. By analyzing where business is coming from on both ends of the tail, you may be surprised that the long-tail is equally, if not more, responsible for driving volume.
  • Where You Stack Up in the Industry – Data analytics can show you where you stack up with your competitors, helping you to establish a baseline to measure performance against.
  • Interoperability – One of the holy grails of healthcare is interoperability both within and outside of a healthcare network. Healthcare systems have long operated private health information exchanges within their networks and the Affordable Care Act has helped to promote public exchanges to share data across systems. The continued advancement of this data sharing effort will progressively close the referral tracking information gap that challenges both physicians and hospital executives.

At Intellimed, we have provided healthcare data analytics solutions to the U.S. hospital marketing for 30 years. Contact us to learn more about leveraging data to prevent outward migration and stop physician leakage.

Ed Willard serves as INTELLIMED’s Executive Director of Business Development and is a member of the INTELLIMED leadership team. In his free time, he enjoys soccer and is involved in several local soccer organizations.

physician management, physician liaison programs

By Ed Willard

Using Claims Data for Physician Management Success

Using Claims Data for Physician Management Success

The loyalty of your healthcare organization’s existing referring physicians is critical to its success as is building relationships with new community physicians. As we continue to shift to a value-based payment model, better integration between physicians and hospitals and physician management will become increasingly important for both delivering high quality care and managing costs.

The only way to know what’s working in your physician referral management program is to measure it using reliable data.

The right data can show you:

  • What is happening in multiple service areas.
  • The physician and group practices that are strong targets based on activity.
  • Physician loyalty as well as the strength and quality of physician to physician and physician to facility relationships.
  • Claim-driven referral connections inside and outside of your networks by specialties and sub-specialties.
  • High-volume referral patterns by status (non-network, affiliated, etc.)
  • Physician “splitters” to manage outmigration patterns.

While healthcare claims data will not provide 100 percent of the picture you need, it will provide a lot of it. In fact, claims data is the most valuable data source for effectively managing a physician referral program. 

Physician Liaisons
Physician liaisons play a critical role in the success of physician referral and retention programs. They are on the front lines in creating meaningful relationships with community physicians that drive traffic to your healthcare system. The right data is invaluable to your physician liaison team in helping them achieve their goals around maintaining and growing physician relationships.

INTELLIMED recently surveyed our clients and partners within hospitals to better understand their physician liaison program deployment and incentive practices. The results of the survey provide insights into program design benchmarking of value to any healthcare organization in its physician liaison program. Access the results in our white paper The What & How Around Physician Liaison Program Deployment and Incentive Compensation Practices to learn more.

As part of our survey, we also asked about the challenges healthcare organizations face with their physician liaison programs. Not surprisingly, the biggest challenge – with over 50 percent of respondents reporting it as a moderate to large problem – required the right data to resolve it:

Measuring actual referral volume to facility

Claims data can provide insights into the referral volume from physicians from both inside and outside the facility and its networks. This data is not only valuable to physician liaisons in helping them know how well their efforts are paying off, but it’s also of great value to upper management in knowing how well their investment in their physician liaison program is doing.

Claims Data & Strategic Decision Making

The data can help guide strategic decision making at the management level to determine:

  • How do we maximize profitable volume?
  • Do we have the right relationships in place to act on our strategic plan?
  • Are we making good physician alignment decisions?
  • Where are the opportunities for service line expansion and revenue growth?
  • Can we execute our service line strategy with our current providers?

Claims Data Set Requirements
To answer these strategic questions, a claims database must be robust enough. It should contain the following information for optimal analysis:

  • Physician demographics
  • PCP and specialist referring and attending physician detail
  • Referring physician facility affiliations
  • Affiliated and out-of-network physicians as defined by your market
  • Pay-mix information
  • Outmigration volume (competitor data)
  • Regular data updates and drill down capabilities

Again, additional data will likely be needed for a 360-degree picture, but in our experience starting with claims data will provide very good insights for physician liaisons on the frontlines as well as guide strategy at the top around physician management.

Ed Willard serves as INTELLIMED’s Executive Director of Business Development and is a member of the INTELLIMED leadership team. In his free time, he enjoys soccer and is involved in several local soccer organizations.

Big data and healthcare.

By Ed Willard

Why Utilizing Insurance Claims Data is Necessary for Any Healthcare Strategy Team

Why Utilizing Insurance Claims Data is Necessary for Any Healthcare Strategy Team

Using insurance claims data for strategic healthcare decision making and understanding market dynamics is relatively new to the healthcare market, and it is becoming a necessary part of any strategic planning process. While using claims data in this way can be very valuable, there are some principles to keep in mind to ensure you obtain the most benefit from the data (and avoid the mistakes many organizations have made when pursuing claims data).

How Do You Ensure the Claims Data You Acquire is Actionable?  
Only robust, transparent and detailed claims data is valuable in organizational strategy. The following factors are critical with regard to claims data:

  • Coverage: When exploring non-institutional claims data, the most important factor to consider is whether the data has enough market coverage – at a minimum, it will have 65 to 85 percent coverage. Without at least this level of coverage, you won’t be able to get a holistic view of the market, understand your competitors’ activities or use the data to analyze market dynamics.
  • Transparency: A lack of comparable, transparent healthcare data is an ongoing obstacle for most organizations and extends to claims data as well. When it comes to transparency, claims data should be cleaned and updated frequently as well as managed for duplicates. Additionally, stay away from data providers that don’t offer transparency in types of insurance companies, shared patients, etc. The more transparent the data, the more accurately you can understand the market and, in turn, craft stronger strategic objectives and action plans.
  • Detail: The level of detail in claims data is very important as well, notably for more complex decisions such as increasing market share among specific insurance companies or understanding physician outpatient activity by procedure, by specific payer and by location.

Is Claims Data Alone Enough?

While claims data is a critical part of data-driven decision making, we at INTELLIMED, a healthcare data analytics company, are the first to acknowledge that claims data alone will not provide all of the data needs for strategic decision making or deliver a full picture of the healthcare ecosystem of a city, state or region. Claims data definitely offers a large portion of what is needed, but not all.

By combining claims data, available state discharge data, and demographic data with a healthcare organization’s own data — including information from its electronic medical record (EMR) — claims data can be used to understand what is happening within an organization and within the external environment. The EMR in particular, with its rich information around patient encounters and clinical data, can yield a more detailed view of a patient’s progress through the encounter and his or her status at discharge, while the claims data will provide a holistic view of the patient’s interaction with the healthcare system.

What Can Be Done with Claims Data?

Every healthcare encounter creates a claim for payment from physicians, hospitals, pharmacies and other healthcare providers. There are two ways that claims are submitted and the data collected:

  • UB-04 is the standard billing form used by institutional providers for claim billing. Although it was developed by the Centers for Medicare and Medicaid (CMS), it has become the standard form used by all insurance carriers.
  • CMS-1500 insurance claim form is used for fast professional health care claims submission. The CMS-1500 form is the standard claim form used by a non-institutional providers or suppliers to bill Medicare and commercial carriers. Durable medical equipment providers also use this form to bill regional carriers.

Among the more common uses of external claims data is accessing outpatient market data to understand the connections between doctors, patients and payers beyond the inpatient setting. Other purposes include utilizing the data for physician relations and marketing, including increasing physician market share, facility loyalty and other physician patterns. Using data strategically for both patient- and physician-focused marketing campaigns can yield a positive return on investment.

Additionally, claims data can be mined for important information that has an impact on decisions in many areas, including competitors; service line expansions, decreases or closures; purchase of independent physician practices and clinics; and marketing and pricing strategy, including:

  • Which hospitals have the highest and lowest prices by service line.
  • How far consumers travel for services.
  • Which health plans provide the best discounts and pay the highest by service.
  • Emergency department and outpatient usage among commercial and non-commercial consumers.
  • Utilization patterns of the commercial and non-commercial population.
  • Payer mix by geography, specialty, and procedure, among other factors.

While all healthcare organizations have access to their own internal claims data, there is no publicly available source for competitor claims data, therefore it is essential organizations find trusted partners who have extensive claims data to support strategic decision making. Internal data, along with state discharge data, simply is not enough in today’s increasingly competitive marketplace

A New Data Paradigm
The changes in the healthcare system at all levels triggered by the Affordable Care Act (ACA) have put new emphasis on using claims data to facilitate cost savings at a system-level and for aligning with value-based purchasing initiatives. Claims data can also help to determine whether established clinical and quality safety guidelines are being met. In addition, to achieve the three goals of population health management and analytics: improved outcomes, increased patient safety, and decreased costs – which many organizations have prioritized – combining claims data with clinical data is absolutely essential.

ACA, coupled with the trend of an increasingly active healthcare consumer, has shifted the way healthcare organizations view market share. In fact, developing market share has drastically changed in the last few years. No longer are the days of a volume-based approach focused solely on patients in beds and emergency department usage.

The focus on delivering patient-centered care – one of the “Aims for Improvement” in the Institute of Medicine’s 2001 report, Crossing the Quality Chasm: A New Health System for the 21st Century – is shaping a new paradigm around market share and using data for strategic decision making. Factors such a facility convenience, online reputation, facility and physician ratings, and other variables are all influencing consumer choice. Organizations must market as much to the consumer as to the physician. Many healthcare organizations are looking to the best practices of retail marketing to reshape their consumer interactions.

Using data – including robust, transparent and detailed claims data – will allow healthcare organizations to be aware of the elements that have an impact on their market, a critical factor in organizational strategy and decision making. Such an approach will allow healthcare organizations to evolve with the new landscape and set the course for where they wish to be in the near as well as more distant future.

Ed Willard serves as INTELLIMED’s Executive Director of Business Development and is a member of the INTELLIMED leadership team. In his free time, he enjoys soccer and is involved in several local soccer organizations.

Insights from The Healthcare Marketing & Physician Strategies Summit
physician leakage, outward migration, healthcare data analytics, big data healthcare
Physician Leakage & Using Data to Prevent Outward Migration
physician management, physician liaison programs
Using Claims Data for Physician Management Success
Big data and healthcare.
Why Utilizing Insurance Claims Data is Necessary for Any Healthcare Strategy Team