In the modern healthcare landscape, the need for reliable physician intelligence and a strategic physician relations strategy is only continuing to grow. With 32 million newly insured Americans entering the healthcare system as a result of the Affordable Care Act and a physician shortage—projected to climb to more than 90,000 by 2020—healthcare providers must have a comprehensive understanding of the physician relationships within their market, the available service line opportunities, and an accurate measure of inbound and outbound patient trends in order to stay ahead of the growing healthcare need.
When building a physician relations strategy, it is important for healthcare providers to be tapped into a reliable data source and a trustworthy physician referral tool. An understanding of the datasets available and reasons why certain physician tools use certain datasets can empower you to make the right decision in the tool that will best suit your needs.
Using the best available data can provide a clear roadmap for health providers focused on strategic growth. By fostering effective communication with physicians, relations experts can identify trends, issues, and opportunities and ultimately improve the overall quality of patient care delivered to their service area by accurately understanding the market needs. There are three main data sources to consider. Use of one or more of these datasets can be helpful when building a well-rounded physician relations strategy.
Internal Patient Data
Internal Patient Data is the most powerful option available. Many organizations underestimate the power of their patient data for strategic planning and physician relations. As the data source, it’s the one opportunity for a healthcare provider to have control over how well their data is collected, secured, and preserved. Internal Patient Data gives you the opportunity to collect more comprehensive data regarding health services received, especially among populations who are continuously uninsured and would therefore have no other medical record available. It is the definitive source for your market penetration and volume trends. A good Electronic Health Records (EHR) system will ensure data is accurate and is a helpful tool for making evidence-based decisions about patient care improvements and hospital planning.
A CRM system is recommended for healthcare providers to manage all areas of their system and ensure that their data meets certain standards. A CRM is ideal for improving physician relations as it makes it easier for physician liaisons to manage referral communications and track activity between physicians, specialists, departments and facilities.
All-Payer Claims Data
In general, All-Payer Claims Data (APCD) is used to report cost, use, and quality information. The data consists of “service-level” information based on valid claims processed by health payers. Service-level information includes charges and payments, the provider(s) receiving payment, clinical diagnosis and procedure codes, and patient demographics.
Some players in the healthcare data market, who claim to have the best coverage with APCD, boast information on 90 percent of a market’s employers (i.e. commercial payers). From the way that percentage is framed, one might think that APCD provides a nearly complete picture of the market in question. However, the reality is that while 90 percent of commercial payers is certainly a large portion of that subsection, in actuality, it only represents a small percentage of the total population of that market.
A big downside to APCD is that provider claim submission is inconsistent, unorganized, and often incomplete. This means that once the data is in hand, additional work, usually in the form of modeling, is required to clean and make sense of the data and get it to a point where it properly represents the market. Even with this additional work, due to holes within the data acquisition process, it is impossible to get a complete picture of the whole market using APCD. All of this additional processing leads to higher costs and in the end, a still incomplete picture of a market. This list of downsides led the Stratasan development team to conclude that APCD was not the right fit as a dataset foundation when building our latest physician relations tool, Physician Pathway.
Medicare is often considered the cleanest external dataset available because it is drawn from a single payer source and the process is standardized across all collection points. The streamlined, standardized nature reduces the need for follow-up cleaning in order to effectively harness the data. The re-organization and modeling required with APCD, and the costs associated with those extra steps, do not apply with Medicare data.
Medicare provides claims data (i.e., data generated by billing) for all Medicare patients across a wide variety of care settings including outpatient, inpatient, skilled nursing facility, hospice, home health agency, and more. In addition, Medicare data can be linked to a variety of other datasets using unique patient identifier numbers.
Medicare data is primarily for patients 65+ or those with special medical needs. It therefore represents the largest utilizers of healthcare. This data is collected with the goal of improving the standard for how patients are cared for across all areas within a health system and it provides a compelling picture of the direction of the healthcare market. For many users, this directionally correct data, which is refreshed quarterly and annually, meets the needs for planning and mapping growth projections. The strengths associated with Medicare data were compelling reasons for the Stratasan development team to choose this as the dataset foundation when building Physician Pathway.
The Physician Pathway Approach
Stratasan’s tool for planning and tracking a physician relations strategy, mapping service line opportunities, and accurately measuring inbound and outbound patient trends is Physician Pathway.
The Physician Pathway tool provides information that recruiters, physician liaisons, and business development professionals can use to have more informed conversations with their physicians, thereby building and strengthening those relationships. Stratasan chose Medicare Data when building Physician Pathway because of the cost savings that would be passed on to users and the trustworthy market overview this dataset provides.
Physician Pathway reports can be trusted and used by physician liaisons with confidence because the numbers presented are real in that they are based on actual numbers, not modeled data. Because of this, they tell an accurate story that does not present a problem when reviewed by the physician. Physician Pathway presents real data with no “black box” models. By not modeling data and instead, presenting reality, you can improve your relationship management by knowing and discussing concrete facts.
If your hospital system is in the business of physician relations, be sure to carefully consider the datasets, tools, and practices you are using to track leads and referrals. If your team is not actively using a physician referral tool, consider how it might be the right addition to your growth strategy. Contact Stratasan to learn more about the Physician Pathway platform and arrange for a free strategy session with our product specialist.
Article by Tony Camarata, Product Manager for Stratasan.