Patient Share of Care: The Revenue-Based Metric Every Health System Needs

Despite the financial blows delivered to the country’s healthcare systems during the past two years, many organizations continue to operate in a predominantly fee-for-volume environment while slowly transitioning towards a value-based care model. However, its well known that you can’t ride two horses at the same time. This idiom holds true in healthcare as systems struggle to flip the healthcare paradigm from volume to value. Uniform patient growth and retention strategies simply can’t thrive in care environments with divergent business models. 

Fee-for-volume is focused solely on attracting and pushing more patients through the system while Fee-for-value strives to manage the care of a specific population in a more cost-effective and quality manner. Because most organizations can’t simply switch from volume to value overnight, they must learn to survive in both worlds. Organizations must have strategies in place to support both business models. Patient attraction strategies will support organizations continuing to thrive in today’s current fee-for-volume environment. Patient retention strategies support the latter.

At the height of the pandemic in 2020, more than 40%[1] of patients opted to forego medical treatment. Empty waiting rooms and temporarily closed practices were commonplace. Today, as the population adapts to living with COVID as part of our daily experience, health systems are working hard to recover and retain their patients. In support of this recovery, HSG, a respected national healthcare consultancy, is providing healthcare organizations with best practices for measuring, reporting, and building strategies around patient share of care. HSG Patient Share of Care™ is a revenue-based metric that comprehensively evaluates the total spend of a patient on their healthcare services (inpatient, outpatient, ambulatory, physician office, etc.). This is an expanded offering of HSG’s successful Healthcare Network Integrity service line.

Just as other industries utilize measures for “share of wallet,” patient share of care should be a health system’s primary metric to measure patient loyalty and inform strategic plan development. The new HSG offering enables an organization to comprehensively understand how differing patient populations are utilizing healthcare services in the market. With this information in hand, strategies can be developed to maximize patient attraction and retention for a specific market in both a fee-for-service and a fee-for-value reimbursement environment. 

HSG Patient Share of Care leverages all-payer, all-sites-of-care claims data. By aggregating and directing line-level patient data, HSG can provide health systems with customized performance measurements and benchmarks for current total market share of wallet performance. HSG can then facilitate the development of strategies for improving overall system performance as well as service line and geographic market performance.

HSG Patient Share of Care helps health system executives build a comprehensive view of patient activity within their market and enables health systems to answer questions such as:

1. Where are the largest gaps in overall patient retention?

2. When patients leave our system for any service (inpatient or ambulatory), what competitive providers, health systems or other services do they seek?

3. How does patient retention differ at each of the following levels?

a. Geographically (Figure 1)

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b. Individual service and sub-service lines (Figure 2)

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c. Individual primary practices and/or providers

d. Patient access points (inpatient, outpatient, emergency, urgent care, physician office, etc.) (Figure 3)

3.png

4. How brand loyal are patients to our entire health system?

5. What are our biggest opportunities to improve patient retention?

Once a health system can properly measure patient share of care for distinct patient populations and develop strategies to maximize patient retention within the system, implementation of the strategies is where the real work begins. Internal education and reporting mechanisms required to operationalize patient share of care metrics throughout the health system is not simple, but  can be extremely effective if done well.

Patient share of care should become your organization’s primary value measurement of patient brand loyalty. Its ability to measure how quickly new services gain traction, how integrated your network is and your health system’s lifetime value of a patient will support your patient retention strategy development more than any other metric. Proper measurement, followed by better implementation, will increase patient retention and maximize revenue generation for your organization.

To find out more about your healthcare organizations patient share of care, call the healthcare business experts at HSG, (502) 814-1198 or visit the website at HSGadvisors.com.

 

[1] Kelly E. Anderson, MPP1Emma E. McGinty, PhD, MS1Rachel Presskreischer, MS1; et al, Reports of Forgone Medical Care Among US Adults During the Initial Phase of the COVID-19 Pandemic, JAMAnetwork https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2775366

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