In the ever-evolving healthcare landscape, prioritizing initiatives to improve margins is essential for maintaining financial stability. In our previous video and article, we discussed how a healthcare system on the East Coast utilized Network Integrity to enhance patient loyalty and achieve better outcomes for its entire hospital system. For the final segment of our series, we will discuss how the Blue & Co. team can help your hospital system improve your network integrity and see positive returns. Consider this your Healthcare Roadmap to Success with Network Integrity.
The reports generated through a Network Integrity analysis provide organizations with data to develop a roadmap to improve market share and, in turn, improve margins.
As leaders build their strategies, areas that they may find and can focus on are the following:
- Meeting with splitters to discuss outmigration patterns
- Reviewing relationships with contracted providers to view where they are performing their procedures and referral patterns of their patients
- Strategic placement of providers in certain markets where leakage is occurring
- Improving access to identified service lines
- Identifying barriers that prevent seamless referrals
- Improving relationships with referring physicians
- Forming strategic partnerships with physician groups that are splitting their business
- Develop business cases for service lines that do not exist in the health system and the data shows there is a need in the market
- Improve patient experience in the referral process to decrease leakage
- Evaluate competitor data and develop a strategy to move leaked procedures back to the health system by evaluating rendering providers’ relationships
Curating Recommendations to Seize Opportunity
Common strategies that organizations can focus on are access, patient experiences, provider experience, and improvement opportunities. The following roadmap is an example of what leaders can build after a Network Integrity analysis has been completed.
Collecting Medicare Data
The claims data is collected using secured data. The lag time for Medicare data is approximately six to nine months, while the lag time for Commercial, which includes Medicare Advantage, is three months (but can vary depending on the data source and/or vendor). The claims are blinded to ensure the confidentiality of patient information and other HIPPA requirements with resulting variables for patients that can include charge data, a random patient identifier, procedure reflected as CPT code or MS-DRG, and the patient’s zip code location. The database allows management teams to analyze any hospital or individual physician based on an NPI, the charges incurred based on date, procedure, geographic location, and insurance payor, which is not an inclusive list.
How Network Integrity Analysis Can Help Your Organization
These are the strategies we’ve employed at several of our healthcare clients to improve their patient loyalty. Most hospital systems struggle with understanding their referral patterns and keeping patients in-network, so let Blue assist your organization in understanding the data to come up with a solution.
Healthcare organizations focusing on improving margins can start by performing a service line assessment. A data-driven method to get a baseline of the current state of the service line can be done by performing a Network Integrity analysis using claims data, and in doing so, organizations can develop strategies that can prevent leakage, improve the experience, and evaluate new growth opportunities that can improve the bottom line.
Contact Us
If your healthcare organization has any questions or would like to learn more and how Blue & Co. can help, please reach out to your local Blue & Co. advisor or one of our experts below.
