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 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.
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