Physicians are the lifeblood of healthcare organizations; by providing excellent patient care, they foster patient loyalty and bring revenue into the organization. Since they are so vital to healthcare operations, health systems need to keep their physicians productive and engaged. The best way to accomplish this is through a focused physician engagement strategy.
The first step in creating this strategy is collecting and analyzing data about physicians and the patients they treat. Specialized physician liaison teams use this data to inform their outreach strategies and ensure their efforts are communicated properly. This outreach is intended to help physicians improve the care they are giving their patients, handle issues physicians may be facing in their work, increase the number of in-network referrals physicians are providing, and boost financial performance.
Let’s look at how healthcare organizations can use claims data insights to create successful physician outreach efforts:
How to Acquire and Organize Claims Data
Claims submitted by physicians or by health systems on behalf of their physicians detail the services rendered to a patient. While this data is first and foremost used by health insurers, available claims-based data is also a potentially valuable tool physician outreach teams can use to improve physician engagement and support overall goals of the health system.
For most health systems, acquiring market level claims data on their own is cost prohibitive. The available data today were originally requested by deep-pocketed pharmaceutical and medical device firms that had teams of analysts able to pore over it and develop insights. In the past decade, however, we have seen technology companies emerge with solutions that ‘democratize’ these data so health systems can better afford and utilize it.
These Physician Market Intelligence platforms summarize the vast quantities of data to make it accessible and able to be interpreted, and perform analytics to reveal otherwise unknown insights. Bringing this all together is a challenging task. Beyond the sheer quantity of data involved, there is no complete source of all physician activity in the nation covering all payer types – this means there is a fragmented ecosystem of claims data vendors with no single one possessing ‘the best’. Thus, solutions providers must seek claims data ideally from multiple sources. It is also important that the data be as current as possible since recent data is most likely to give you the most actionable insights.
Example Claims Data Insights
A physician relationship management platform (PRM) with market intelligence is able to provide insight into physicians’ referral activities based on the organized claims-based data. A physician liaison team can filter this data by type of activities, such as inpatient versus outpatient hospital interactions, in addition to filtering based on which locations doctors are seeing patients, what services they are performing in those locations, and what the payer mix is of the patient panel. Important analytic insights solutions can provide include calculations of referring tendencies, which is information not generally available on raw claims data.
There are numerous queries that can be answered about specific physicians with this data, including:
- Is this physician being loyal to the organization and referring in-network?
- Are in-network physicians receiving referrals bringing the cases to competing organizations or locations?
- Is there a specific physician another doctor is referring to frequently?
- Are there doctors this physician never refers to?
- Who are the busiest physicians within a particular specialty in my market, and who sends them their patients?
This type of information is what physician liaisons call “actionable insights”. It can be used to both determine which physicians to target and bring into better focus what to discuss with them.
An additional capability of a strong PRM is integrating insights from claims data with liaison outreach activity data. By doing this, physician liaison teams have more visibility into which outreach efforts are successful and which are not, helping to focus outreach on the most profitable actions. Importantly, a PRM becomes a living record of physician feedback, issues and their resolution. With this record, campaigns can run to better enfranchise and engage physicians. With some level of integration, or simply by bringing data elements together from other parts of the health system, organizations can tie changes in physician behavior directly to outreach and campaigns, providing a measure of the ROI.
Why Should You Use Claims Data?
As noted, claims data can help a health system and its liaison team better engage and align physicians. For today’s healthcare organizations this is critical, as engaged physicians are more likely to refer within their healthcare organization’s network. A Gallup study found that engaged physicians gave their hospitals 51 percent more inpatient referrals than physicians who were not engaged. The result is an increase in both initial revenue, as well as an increase in the number of returning patients.
Another key reason healthcare organizations should use claims data insights to engage physicians is because engaged physicians are typically more productive. The same Gallup study found engaged physicians were 26 percent more productive than physicians who were not engaged, equating to $460,000 more patient revenue per physician per year. Take that number and apply it across a healthcare organization’s entire range of physicians, and your physician engagement strategy may result in an enormous increase in earnings each year.
With an effective physician alignment strategy, health systems may be able to deepen referral networks to both protect and grow market share. Physician outreach teams need to take advantage of data, employ targeted communication strategies, and resolve issues effectively to ensure physicians are committed to delivering the highest quality care and interested in referring to in-network specialists when needed.
Claims data, while once only used for insurance, pharmaceutical, and medical device market intelligence purposes, are actually an incredibly valuable tool for health systems to gain insight into physician activity. This includes market-level referring tendencies, which have historically been a major blind spot. Importantly, improving physician engagement using claims data in combination with a robust physician relationship management platform has been proven to increase profits. One large hospital system found that the impact of physician liaison activities across its network were able to deliver a contribution margin of $31M in a single fiscal year, an ROI figure of 10.6:1.
Note that claims data insights are not just ‘offered up’ and there isn’t yet an all-encompassing solution that answers all health system questions. Different solutions address different market needs and, typically, health systems utilize a mix of solutions to get a comprehensive view on their competitive environment. If you are considering investing in a solution, or replacing an existing solution, be sure to do thorough due diligence and select the solution that is right for your organization.