With the movement from fee-for-service models towards value-based care—which emphasize the whole patient and care quality, rather than siloed care and serving as many patients as possible—techniques for driving revenue must be updated to align with the evolving healthcare market. Targeted service line development and growth does still fit into these new value-based care initiatives.
When it comes to growing service lines, physicians remain a crucial part of the equation. Healthcare organizations need to be more strategic about their physician engagement and alignment in order to effectively grow service lines—and the organization—effectively in this new environment.
Regardless of where your organization sits on the journey to increased value-based care, proper physician alignment has benefits that resonate throughout your organization, such as:
- Increased Inpatient Referrals: According to Gallup findings, engaged physicians gave their hospitals 51 percent more inpatient referrals than physicians who were not engaged. The result: an increase in initial revenue, as well as inpatient retention numbers. Keep in mind that in-network referrals are incredibly valuable—referrals from a single physician are estimated to bring in $1.56 million in net revenue.
- Greater Productivity & Revenue: The Gallup study also found that engaged physicians were 26 percent more productive than non-engaged physicians. This added productivity can result in $460,000 more patient revenue per physician per year.
- Improved Patient Experiences: Physician alignment is crucial for a smooth transition to value-based care models, which support patients taking a more active role in their own care. By aligning physicians with your value-based goals, you encourage them to better engage with patients throughout new types of care journeys that not only treat current health issues, but prioritize health maintenance to prevent further complications. Creating these types of patient-focused experiences is crucial to your organization’s financial performance; an Accenture study found that U.S. hospitals that deliver superior patient experiences generate 50 percent higher margins than average providers.
Achieving alignment requires a comprehensive physician alignment strategy. This involves engaging physicians through a data-driven and informed outreach program, typically executed by specialized physician liaisons. The ultimate goal is to build meaningful relationships with providers that lead to service line growth.
Strategies for Achieving Growth-Focused Physician Alignment
Use these market data, referral network, relationship management technology, and optimized liaison team strategies to effectively align physicians with your organization’s growth goals:
Gain Insights from Claims Data
Physicians naturally submit claims to insurers to provide details of services rendered to patients in order to be paid for their services. However, your physician alignment teams can also use claims data to identify the best growth opportunities—such as by examining physician volume and referral patterns. You can also differentiate between inpatient versus growing high-value ambulatory patient interactions, the locations of care, services performed, and payer mix. Having these insights for an overall market (not just your own data) are not typically generally available and require an advance PRM solution with data insights.
Understanding referral patterns is crucial, it’s like having the answers to the test before sitting down for the exam. It can provide a roadmap for outreach and focused, informed conversations. Most physicians understand that referring in-network helps with care coordination and supports better outcomes. However, often they don’t know all the in-network providers and therefore often provide referrals to trusted doctors regardless of affiliations. Armed with the knowledge of referral patterns prior to a meeting, an outreach team can better guide the conversation and uncover underlying reasons for referral patterns.
If physicians refer in-network, they help drive patient loyalty to your organization, which has enormous financial impact. Out-of-network referrals cost health systems an average of 55 to 65 percent in net revenue, which can equate to about an $821,000 to $971,000 loss per physician per year. If those patients were referred in-network instead, revenue would remain within your health system. Thus, service line growth is heavily reliant on optimizing physician referral practices with informed, all market data-driven insights.
Integrate Relationship Management Technology
Collecting, organizing, and evaluating service line claims effectively requires advanced data organization and analytics. A specialized physician relationship management (PRM) platform with market intelligence can provide these capabilities.
A PRM acts as a centralized hub for physician alignment efforts by consolidating disparate physician data like office locations, specialties, referral practices, case volumes, and more. Using its analytics capabilities, teams can generate actionable insights to inform outreach efforts, such as identifying high-priority providers by service line.
A sophisticated PRM will also enable collaboration and data-sharing amongst liaison teams. As the ones executing outreach and communicating with providers, liaisons need access to in-depth data so they know who to talk to and key points to include, such as their specific in-network versus out-of-network referral numbers, quantitative service line revenue goals, and more. This enables liaisons to have more productive and strategic conversations.
Liaisons are also able to input notes about conversations with physicians directly into the PRM and document issues to initiate issue resolution workflows. This can give the broader organization insights into how to increase referrals whether that’s through operational and staffing improvements, core process changes, equipment or facility upgrades, or simply facilitating introductions between physicians.
Appoint Physician Leaders
Outside of communicating service line growth goals and strategies through liaisons, also consider initiating alignment-focused physician-to-physician communication. These peer-to-peer conversations inject a level of credibility to an organization’s alignment efforts.
Start by selecting physicians within each priority service line—perhaps they’ve have been with your organization for a long time or already have particularly high levels of engagement and respect within the organization. If not yet fully known, you can also identify these high potential physicians by analyzing PRM data. The next step is to create partnerships with these physician leaders; giving them visibility into how service line growth can lead to both better patient health outcomes and higher levels of physician satisfaction.
Give physician leaders opportunities to connect with their fellow providers and discuss growth tactics like increasing in-network referrals on a peer-to-peer level. These opportunities could be service line-wide hosted seminars or one-on-one conversations with individual doctors over lunch. By incorporating physician thought leaders into outreach efforts, better alignment can be a real result. While often already incorporated in core liaison outreach strategies, the shifts and emphasis on value-based care require health systems to double down on data-driven, informed physician alignment efforts.
Physician alignment initiatives for service line growth require organization-wide support. Start from the top down—C-suite executives must understand the value of physician alignment so they will place budget and other resources behind it. The good news is more than half of executives already identify referrals as an area of focus to drive growth.
Use data, quantitative analysis, and sophisticated predictive models to show the C-suite what kind of financial impact strong physician alignment can have on service lines in your organization. It’s also important to give executives updates on alignment strategy progress, typically on a monthly or quarterly basis. By involving key decision-makers in your physician alignment strategy, you help make it a priority across your organization.
As healthcare continues to shift toward value-based care, physicians’ impact on patient experiences and revenue will only increase. By aligning physicians within your priority service lines, you will see service line growth, improved patient outcomes, and ROI.