Solving for Referral Leakage and Outmigration

Solving for Referral Leakage and Outmigration

How Stratasan’s ZIP5 Patient Origin Modeling Can Help You Identify Trends and Opportunities

By Michael Shipley, Morgan Atkins

Stratasan recently began offering a new capability: ZIP5 analysis of our All-Payer Claims Database. This capability helps health systems and hospitals better assess critical business performance in areas such as patient outmigration and physician referral tracking.

Stratasan assigns a ZIP5 to patient IDs in order to provide an enhanced level of granularity. The ZIP5 assignment is for All-Payer Claims 837 submit data since that is the data being rolled up to the ZIP. This modeling is based on the patient’s observed healthcare utilization from All-Payer Claims Data (APCD). In this blog, we’ll explore our methodology for ZIP5 modeling, but first, let’s explain why this level of insight is useful.


Geographic Analysis and Quarterly Reporting

Regular geographic comparison and analysis across multiple data sets is necessary to inform and validate the data you're using in your strategic planning. Stratasan makes this possible through our ZIP5 patient origin modeling, which makes it easy to track the success of outreach programs and marketing campaigns on a regular, ongoing basis. It also enables more in-depth, meaningful physician referral tracking and monitoring of patient outmigration trends.

Tracking Physician Referrals and Patient Outmigration

Often when considering how to grow or improve bottom line profits, patient outmigration and physician referral leakage are top of mind. Patient retention and well-maintained physician relationships are key to maintaining a strong financial standing. This is especially important for rural hospitals at a high risk of losing patients to nearby cities, and for large urban hospitals with lots of competition for market share. 

Careful ZIP5 analysis can be useful in determining points of leakage (i.e. revenue loss). By pulling a list of patients in a specific ZIP, then comparing destination patient ZIP5 information, it’s possible to see a longitudinal view of the market and identify referral patterns that spark concern. This intel can equip planners and physician liaisons with exactly what they need to secure referrals and reduce costly outmigration.

Stratasan’s ZIP5 Methodology

One of the impacts of HIPAA implementation is that patient origin details are released at a ZIP3 level. This means that ZIP5 patient origin is not available through unmodeled patient origin data, and the insight accessible through this data is limited. That’s why Stratasan assigns a modeled ZIP5, so that our partners can be equipped with the level of insight they need for effective analysis and planning, while maintaining patient privacy via a de-identified data set that supports HIPAA compliance.

To determine a patient's modeled ZIP5, we look at care settings that are highly correlated with where a patient lives. We emphasize five primary sites of care, and within those, assign precedence based on the types of care for which a patient is more or less likely to travel greater distances:

  1. Office
  2. Urgent Care
  3. Emergency Room
  4. Hospital - Inpatient
  5. Hospital - Outpatient

We exclude care settings that typically are not correlated with where a patient lives, such as Laboratory, or a Home Health billing agency. Our logic looks beyond a pure site of care utilization. For example, a Primary Care visit is typically weighted higher than another visit, regardless of site. 

Knowing that patients will likely seek care close to where they live, we’re able to apply assumptions that we believe accurately model ZIP5 patient origin. Applying healthcare utilization logic and site of care destinations is a combination we strongly stand behind to deliver dependable results for successful growth planning. 

Other vendors use a variety of ZIP5 methodologies that often involve a black-box approach to modeling. At Stratasan, however, we believe in data transparency. We feel so strongly in transparency that we’re willing to fully and openly share our approach to ZIP5 modeling.

The Takeaway

If our ZIP5 patient modeling methodology sounds like an offering that would be valuable to your team as you address costly patient leakage and worrisome physical referral patterns, then reach out to a member of our team today. Schedule a demo with one of our data experts and find out how, with our data insights, you'll be better equipped to address fluctuating market dynamics, improve patient tracking, and add depth to your physician conversations.

Article by Morgan Atkins, VP Product and Innovation, and Michael Shipley, Senior Product Manager for Stratasan

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