Q&A: The Art & Science of Understanding Physician Activity and Referral Patterns

Hospital Physician Referral Understanding which physicians are sending which business where is an art and science. In today’s competitive healthcare environment, it’s critical for hospitals and health systems to attract and retain physicians who will drive patient volumes, increase referrals, and enhance the patient experience. In order to get actionable insights on an entire market that will ultimately improve knowledge, health systems must use a data-driven approach.

However, there are some data-related challenges to understanding physician activity and referral patterns. These ultimately trace back to several deficiencies in today’s available claims data, which makes learning how to interpret and leverage it critically important.

During a recent webinar, Emilio Ruocco, VP, Physician Solutions Practice Leader at Evariant, shared his insights on claims data sourcing and the components of a high functioning claims database, demonstrated interpretation of claims data in a market intelligence platform, and discussed how to leverage these data outside of a platform.

In case you missed the webinar, here’s a quick summary of several key takeaways along with the audience questions and answers:


What internal departments need to be involved with the process of bringing together data and analytics to implement a Physician Relationship Management (PRM) solution?

In addition to the eventual core users of a platform, the two departments likely to be involved are project management and IT. Strong project management on both the client and vendor side simply makes any implementation faster and better. Since IT resources can be scarce these days, their role can be minimal or potentially eliminated if the market intelligence solutions can be implemented quickly without the need for internal data feeds.

Primarily, this means eliminating the need for a client to furnish a provider directory to the solution vendor. The vendor’s provider directory can be the baseline for both the client’s and broader market providers. If a health system wants to push their own provider directory into a PRM and market intelligence solution, it does typically require additional IT work since the important demographic information can often reside in several different places.

One other IT dependency is whether the vendor being used asks for the health system’s encounter data to be added into the underlying market claims data. In most cases, the feed of the encounter data that is owned by the health system is used as an input point for modeling and estimating. Modeled data poses its own challenges, however, due to the high variability of accessible claims data. There are solutions that don’t require that information because they choose not to model and estimate – they only work off actual claims data – which do not require this type of feed.

I work out of Excel files to track my physician referrals? How would I get started with a PRM solution?

This isn’t an unusual circumstance at all. The good news is it is easy to configure and implement a PRM solution. And, while internally tracked referrals report on what’s happening within the health system, they cannot inform about all of the potential referral relationships in a market. A PRM solution with market intelligence sheds light on this, and should be considered a core tool for a health system’s business development function.

The referral data that can be accessed in a PRM market intelligence solution are, by necessity, calculations and directional in nature. So, the information is different than the information captured in the EHR as part of physician workflows. As a side note, many health systems have found a lot of inaccuracies in the referral data in their EHR. A PRM solution doesn’t replace the EHR, so it’s important to optimize your EHR referral capture. We talk more about how to achieve data-drive physician alignment in this article.

I’m a physician liaison and one of my biggest challenges is when I’m out in the field is trying to keep track of my communications with my physicians. Do you know of any tools or applications that could help me with this?

The foundation is a PRM solution, which builds a living, updating record of all key business development interactions with a physician. For maximum ease of use, your PRM solution must have an easy to use mobile application as a component. When in the field, having access to the outreach history and the ability to know about past and current issues is critical. A mobile application should have the functionality to bring up summary information in an easy to interpret, user-friendly interface that also makes it easy to capture notes and information in the field. Evariant has a solution called PRM Go! that gives your Physician Liaisons the information they need in the field – including key facts about a physician practice – to help you create profitable and mutually beneficial physician relations.

Final Thoughts

Having access to physician data is simply not enough. Effective data sets need to be timely and have as much detail as possible to be interpreted and leveraged. PRM solutions, with market intelligence built on strong claims data, allow health systems to do analyses and gain directional physician insights that can help improve engagement and grow profitable volumes.

Physician Activity & Referral Patterns



Evariant provides a leading healthcare CRM solution suite designed to help health systems transform the healthcare experience for their consumers, patients, and physicians. Built on the Salesforce Platform, our solutions foster richer consumer/patient engagement and tighter physician alignment. Powered by cutting-edge data and analytics, Evariant enables health systems to effectively communicate care options that increase revenue and market share, while optimizing network utilization. Many of the top health systems have selected Evariant to thrive in today’s hyper-competitive and rapidly changing environment.