Physician alignment is only possible with a deep understanding of physician activity. A Physician Relationship Management (PRM) system with market intelligence can aggregate claims and behavioral data to provide a 360° view of physician performance and referring activity across a target market.
Armed with this information, organizations can facilitate meaningful conversations with target physicians who may be seeing patients at out-of-network sites of service, referring to competitive providers and health systems, and more. Data-driven physician alignment allows health systems to catalog, track, and resolve physician issues to bring more cases in-network.
Actionable PRM Insights for Physician Alignment
1. Provider Splitting
A PRM system with market intelligence provides healthcare organizations with detailed information about physician activity at in- and out-of-network sites of service. For example, an in-network provider may be performing outpatient-related services at a competitor facility.
The health system could then put this provider on a target list for outreach and guide the outreach resource on how to frame leading questions to learn why these physicians’ cases are going to a competitor. From there, the organization can track and determine if they can, and if so how they will address any issues preventing the provider from seeing patients at an in-network site of service. The goal: effectively recapturing that revenue.
A PRM system can also bring to life physician referral patterns – optimally both outbound and inbound depending on physician specialty. Typically, health systems looking at specialists’ referrals will be interested in who is feeding them cases. In this example, in-network providers are referring patients to a vascular surgeon, who is seeing these patients at an out-of-network site of service.
In this case, organizations could reach out to referring providers and see if they are willing to refer patients to a surgeon who performs procedures at an in-network facility instead.
3. Service Lines
Provider splitting and referral pattern analysis can begin at the service line or provider specialty level and drill down from there. If you have a physician champion, you may want to start at their service line. Then, analysts can look into referral patterns to see if there are any referring providers who are sending patients to out-of-network specialists. Analysts using claims data-based solutions can also help identify any potential physicians who are taking cases to competing facilities.
This practice will help organizations build out their target lists with providers who are either referring patients to out-of-network specialists or seeing patients at out-of-network facilities.
In order to understand the potential of market intelligence gained from claims data, analysts must know how to interpret it. Often, the data-driven insights needed to achieve physician alignment aren’t served on a platter – the data isn’t perfect, there are no 100% sources of information, but directional data presents substantial potential for actionable insight.
For this reason, it’s worthwhile to utilize PRM solution with embedded market intelligence and develop super users who understand both the opportunities and limitations of directional data.