Network Integrity is the ability to keep patients within the organization-defined provider network and can optimize your hospital’s 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 two of this series, Improving Patient Loyalty with Network Integrity. In our last article and video, we covered the basics of patient loyalty and network integrity. In this video, we will examine how a healthcare system on the East Coast incorporated network integrity, resulting in improved patient loyalty.

Meet Our Healthcare Client

One of our East Coast Healthcare Clients desired to build a strategic plan that allowed them to incorporate current service line market share and leakage to understand current specialties not being offered. They started with primary care. The health system built a “community” constructed of all the employed providers and facility National Provider Identifier. The community provided a baseline for the analysis to understand patterns, trends in migration patterns, and leakage.

Analyzing Leakage Opportunity

After the community had been developed, all employed and contracted primary care providers were analyzed using a trailing twelve months lookback to gauge where a patient traveled to subsequent providers within a 30, 60, or 90-day period after visiting a primary care provider. This first data dive established the health system’s overall primary care loyalty to their system against the other providers in the geographic area. This high-level market share provided an initial picture of their ability to drive specialty and ancillary services.

The other view, using the same data, provided the health system with which individual primary care providers were “loyalists” or “multi-network providers.” Their loyalists followed the patient from the provider to the specialist and those providers that shared 75% or more of their patients with this system’s community provider. Multi-network providers were those providers that had more outmigration, and their patients were split between this health system and other health systems or providers.

This hospital focused on the multi-network providers from their market share analysis, as these providers are more likely to convert patients back versus the providers that did not have any shared visits with this health system. Once the multi-network providers were identified, the health system focused on understanding what referral patterns existed.

Understanding Patient Service Areas

Our client also wanted to understand where patients were choosing to have their care in the primary and secondary service areas.

One areas of focus was ambulatory surgery centers.

The health system started with claims data pulled from patients living in zip codes in their primary and secondary service areas, the procedures the patient had, the provider rendering the service, and the billing provider that included total charges. The data was the analyzed on various data points, segmented by insurance, provider employment status, and health system or individual surgery center billing for the procedure.

The data provided our client with the ability to identify the ambulatory surgery centers where contracted medical staff were sending patients. The analysis also provided what procedures were being done outside of this health system that management might want to consider adding, and leakage of procedures that could be done.

Next Steps

In the next part of our video series, we will cover some of the positive outcome of implementing network integrity analysis at your organization.  

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