Physician alignment + service expansion: How health systems are uncovering hidden opportunities through data and predictive analytics

Many healthcare systems seek to offer new services and increase patient volume to support their contribution margins. Financial pressures are coming from multiple directions, including mergers and acquisitions, the continued closure of critical access hospitals, the shift to outpatient care, and more.

Becker's Hospital Review recently spoke with three experts from Huron about how health systems can improve network integrity and grow through physician alignment and service line expansion:

  • Harold Picken, MD, MPH., chief medical officer
  • Melissa Paufler, director
  • Matt Welsch, senior director

A data-driven approach to referrals enables growth + enhanced patient experiences

When it comes to referrals, a good place to start is understanding how loyal physicians are to other physicians in the health system. One of the best means to obtain that information is through market-based claims data.

"Once you quantify how loyal doctors are to your system, you can begin to focus on relationship management, prioritizing those with the lowest referral rates." Mr. Welsch said. He offered three loyalty classifications:

  • Loyalists keep over 75% of their referrals in the system.
  • Splitters send 25%-75% of their referrals to colleagues within the health system.
  • Non-aligned refers to anyone with internal referral rates below 25%, as they are not aligned with the organization.

With this information, health systems can identify what barriers are preventing physicians from referring more patients within their network. Huron recently worked with a health system that wasn't seeing expected patient volumes in a newly launched pain management service line.

"Using claims data, the organization identified over 260 patients that it lost to a competing clinic in the market," Mr. Welsch said. "Based on that knowledge, the health system identified the physicians who were referring patients to the competing clinic and launched a campaign to build awareness for their new capabilities. Within the first three months, case volumes grew by 30% and revenue increased by over $600,000."

As health systems improve referral rates, they need to be prepared to handle increased volumes of patients and deliver high-quality care. Precision patient marketing is one way to align referrals with an organization's areas of unfilled capacity.

"With precision patient marketing, you sit down with clinical operational leaders and ask where capacity exists in the system and where it's constrained," Dr. Picken said. "These discussions can get to the level of very specific services. For example, an organization may have more capacity for cardiac catheterizations. The key is to match requests for referrals with clinical areas where you are confident that you have capacity and access."

Increased data visibility, combined with governance, enables health systems to take a more systematic approach to referrals and create a cohesive offering that delivers a positive patient and physician experience.

"Another key success factor is breaking down organizational silos and making decisions based on a more complete understanding of the organization," Dr. Picken said. "I've seen cases where a system wants all primary care doctors to send cardiac patients to a particular part of the network, but the name of that practice is on the third page of the referral drop-down menu. No one thought to connect the dots with IT."

As patient volumes grow, it's also crucial to focus on key quality measures. Data reporting and dashboards that quantify the volume of care, as well as measure key performance indicators related to quality and the patient experience enable health systems to better manage demand and maintain quality care.

"It starts with the data, but technology allows you to understand, visualize and summarize what's happening in easy-to-digest formats," Mr. Welsch said.

Predictive analytics shed light on community needs + pathways to serve more patients

With the right data, health systems can build propensity models and use predictive analytics to better understand community health needs and improve population health.

"As an executive team, getting the right data to the right person in the healthcare institution at the right time can make a significant impact on decisions that affect the community," Ms. Paufler said.

A good example is how Huron and Mon Health System (Morgantown, W.Va.) are using a data-driven approach to identify and treat individuals with lung cancer.

"Mon Health System wanted to prioritize their engagement with high-risk lung cancer patients and encourage basic screening," Mr. Welsch said. "We ran our lung cancer predictive model, which is based on the personal clinical history of the patients, and identified those who were at higher risk. Mon Health System stratified that group into low, medium, and high risk and developed communication plans for each segment."  Individuals who had a confirmed diagnosis after screening are now in active treatment.

"It all starts with an eye on the patient," Mr. Welsch said. "If healthcare organizations are proactive and engage patients before they realize that they have a problem, they can make an extremely positive impact on their lives. Understanding the overall market need, and subsequently the needs of the individual patients, allows the organization to carry out their mission of providing the best care to their community."

As organizations leverage data as a tool for growth, best practices are essential

"When we talk about data, it's important to remember that every data element is attached to a person," Ms. Paufler said. "It represents a relationship and trust in the healthcare system. It's also important to ask the right questions because data can get very big very quickly."

Health systems must clearly identify the problem they want to solve with data. The way questions are framed will influence the steps needed to acquire the necessary data. As a result, clarity about the desired outcome upfront is critical. It's also important to use a consistent data set when formulating a strategy and measuring results.

Ms. Paufler also advised that organizations use data that is recognizable and trusted by providers.  You want to have conversations that build trust," Ms. Paufler said. "You're working together as a team."

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