In the ever-evolving healthcare landscape, prioritizing initiatives to improve margins is crucial to maintain financial stability. As inflationary pressures continue to impact labor, purchased services, and supplies, it is imperative that hospital leaders begin to focus on margin improvement initiatives. Understanding patient referral patterns, or your organization’s network integrity, is one way health systems can optimize their financial and operational performance.

Blue & Co.’s Shawn Williams, an Audit Director in our Healthcare Practice and Crystal Bingham, a Manager on the Hospital & Physicians Operations team, have created a four-part video series diving into network integrity and how it can improve margins. The video below is part one of this series, An Introduction to Network Integrity.

Network Integrity in Hospitals

Hospitals can assess their service lines by evaluating the hospital’s individual departments, revenues driven by volume, expenses, productivity, and supply inefficiencies. Deeper dives into staffing models, procedure supply inefficiencies, and scheduling dynamics can provide more insight to leaders to understand the service line business further. To identify what drives patient loyalty, leaders should perform an analysis as to why and how patients choose where they go, and which access point they have entered the system.

Network Integrity is the ability to keep patients within the organization-defined provider network. Network Integrity can optimize your hospital’s financial and operational performance. In this series, we will explore how a health system on the East Coast was able to expand and reinforce their Network Integrity.

Data Benefits from a Network Integrity Analysis

Performing a Network Integrity analysis helps hospital leaders to understand their market share, service line referral patterns from primary care to specialists and the locations of care. Leaders can choose to pull data from a patient or provider zip code, allowing management to analyze the outmigration of patients in their primary and secondary service areas. This evaluation provides historical information within a specified timeframe to better understand leakage over time.

Implementation to Grow Market Share Strategies

The Network Integrity process starts with digesting timely and reliable data before analyzing patient flow through the system. Numerous vendors sell database information through protected means, which allows hospitals to build accurate modeling to develop strategies that incorporate patient charges and volume along a service line and provider.

Timely and accurate data provides the reliability needed to analyze the market data and ensure that the service line strategies to grow market share or prevent leakage are effective. Using data over one year can hinder any modeling by failing to incorporate recent physician changes, facility offerings, or new practice locations. The data should also be from a reliable source, whether it is from public use cost report filings, purchased databases from other governmental sources, and or internal electronic health record information.

Next Steps

In our next video, Improving Patient Loyalty, we will cover a case study, showing how a Health System on the East Coast was able to use Network Integrity.

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