Many hospitals have a problem with network leakage, and that won't fly in a value-based world dependent upon better coordination of care, according to Munster, Ind.-based Community Healthcare System's Catherine Tinsley, vice president of medical data analytics and health economics.
"To look at operational efficiencies and creating better coordination of care, that's how we're going to face the new world. That's how we're going to look at these challenges and serve our populations better. … 67 percent of ACO specialist visits occur out-of-network, and 24 to 30 percent of referral leakage is there," she said, citing a Becker's article. "Who would like 24 to 30 percent more revenue?"
Like many hospital systems, Community Healthcare System asked physicians to refer in-network, but it didn't track whether they actually did. Ms. Tinsley discussed how the system used data analytics dashboards to gain insight into physician referral patterns at Becker's 4th Annual Health IT + Revenue Cycle Conference, Sept. 21 in Chicago.
Ms. Tinsley and her 15-person data analytics team set out to understand how much external leakage was happening and prevent those out-of-network referrals — which cost the system valuable revenue streams. To achieve this two-pronged goal, the team created a dashboard for physician network analytics, another for therapy services referral and a third pertaining to after-visit summaries.
The dashboards yielded actionable results. For instance, the physician network analytics dashboard revealed more than 2,000 referrals were going to a certain urology group. The analytics team realized providers were referring to that group because of its high quality, and Community Healthcare System decided to bring the group in-network as a result. The data also led to the revelation primary care physicians weren't referring in-network for a simple reason: They didn't know which providers were in-network. Conveying this information to PCPs was one way the system put a cap on external leakage.
As the data analytics team created dashboards, it got executive sponsors involved in the process. Since the executives helped make the product, they were more willing to use it — and they encouraged others to use it. With executive backing, Ms. Tinsley said Community Healthcare System is now better prepared for value-based purchasing, physicians are better informed about in-network service offerings and the system is on its way to building an analytics culture.