Increasing Patient Retention Through HSG Patient Share of Care
Many health systems struggle with managing patient retention within their system of locations and loyal providers. Faced with poor data on patient behavior that limits strategic insight, health systems frequently find themselves going down one of three paths:
- They rely on state-level inpatient market share data to draw conclusions about where patients in their market seek care – this strategy completely misses the competitiveness of the ambulatory landscape in each market and does not drive strategic decision making as it relates to patient retention.
- They utilize their own EMR to begin an aggressive Referral Management strategy, focused on identifying referrals leaving the network – this strategy causes health system executives to find themselves confronting providers and their staff about patients not being referred in-network; creating animosity as providers and executives argue over root causes.
- They utilize 3rd-party data platforms that promote their ability to help identify referral leakage, and provide out-of-date, incorrect or ultimately not useful data that the health system is unable to leverage to drive health system strategy, ultimately resulting in the data platform being used as a PRM tool to drive physician liaison behavior or other relatively low value activities.
These approaches largely fail because they do not focus on (or are unable to measure) the fundamental question of “Where do patients go across the care continuum?” – which, by definition, must include very detailed data on outpatient and ambulatory encounters and summarize that data in a way that is useful for executive-level decision making.
THE HSG APPROACH
HSG addresses these challenges with multiple analytic approaches. The four approaches outlined below comprehensively evaluate markets to find areas for incremental patient retention and acquisition.
- Patient Share of Care – Tracking a group of patients across the continuum of care over an extended timeframe.
- Patient Flow – Identifying patient relationships between providers and/or healthcare facilities.
- Provider Location/Service Analysis – Diving into single providers’, or group of providers’, service location activity.
- Market Insight – Studying provider activity across an entire market or specific geographies.
HSG Patient Share of Care, a novel approach to track patients throughout the entire continuum of care is highlighted in this article.
HSG PATIENT SHARE OF CARE OVERVIEW
HSG Patient Share of Care was developed to help health system executives move beyond these challenges and build a comprehensive view of patient activity within their networks. Through HSG Patient Share of Care, health systems are able to answer questions such as:
- Where are our largest gaps in patient retention? When patients leave our system – what competitive providers, health systems or other services do they seek?
- Individual Service Lines
- Specific Services
- Individual Practices
- Specific Providers
- Specific CPTs or ICDs
- What is our market share for patients that are on our primary care provider panels?
- How loyal are established patients to our healthcare system?
- What are our biggest overall opportunities to reduce patient leakage?
HOW HSG MEASURES PATIENT SHARE OF CARE
HSG’s 4-step process for Patient Share of Care measurement is customizable to answer specific health system network needs to begin increasing patient retention.
STEP ONE: Identify “You”
Clearly articulate your organizational definition of what is “In Network” versus “Out of Network.”
Many organizations struggle with defining exactly what network of providers, facilities, ASCs, or other services they want to keep patients within – this step focuses on creating a clear view of a health system’s “network” and becomes the basis for all measurement within the Patient Share of Care framework.
STEP TWO: Identify Providers and NPIs
Clearly define what providers serve the patient populations your organization wants to measure.
HSG Patient Share of Care focuses on the patient panels of individual providers and their associated NPIs. Many organizations want to measure the behavior of patient panels within their employed primary care practices. Some want to understand the behavior of patients touching their entire medical staff. Some want to understand the behavior of patients of an independent practice in their market. Identifying these providers allows HSG to then identify the patients served by those providers.
STEP THREE: Identify Providers’ Patients
Identify all patients interacting with our providers and capture the totality of the care delivered to those patients.
A unique patient identifier will be applied to each patient and all services across the continuum of care associated with those individual patients are tracked. Patient services are tracked at the service location, billing location, and rendering provider levels to provide detailed data on where a patient received service, what organization or practice they saw, and what provider they interacted with.
STEP FOUR: Develop Patient Share of Care Metrics
Develop reports on patient behavior focused on measuring patient retention and patient leakage.
Patient Share of Care is calculated for services associated with that patient population. Percentage of services provided “In Network” versus “Out of Network” can be reported ranging from overall services to service line groupings, down to individual procedure levels.
HSG PATIENT SHARE OF CARE USE CASE
Measuring Primary Care Patient Behavior Across a Statewide Network
A recent health system client with 15+ community hospitals and flagship academic center sought to more clearly understand patient retention as it applied specifically to their employed primary care providers. By studying patient Share of Care at the service line and provider levels, the health system intended to gauge the effectiveness of recent and planned patient retention strategies.
HSG Patient Share of Care Process
- Service facilities were categorized into “Owned,” “Aligned,” and “Competitive” entities as it related to site of service.
- All health system employed primary care providers (500+) were included.
- A patient cohort was created based on established office visits with any of the health system employed primary care providers.
- All claims associated with those patients were analyzed over a 2-year timeframe and rolled up by service lines and reviewed by individual rendering providers.
What HSG Found
For a region of interest, almost all inpatient stays (86%) were at system facilities, with 57% at the region’s community hospital and 29% at the system’s quaternary hospital in the neighboring region. Most specialist office visits were with employed (35%) or aligned (52%) specialty groups. There was minimal overall leakage (8%) to groups employed or aligned with competitive systems.
System-wide Share of Care was 55% to system-owned facilities with an additional 5% to system-aligned facilities. This indicates that 40% of total healthcare revenue from these patients is being captured by competitive facilities and systems. Share of Care was extremely variable by service line resulting in identified need for additional focus and reassessment of organizational orthopedic service line strategy.
Measurement is planned to be ongoing to continually measure strategy success and increase patient retention.
HSG PATIENT SHARE OF CARE USE CASE
Measuring Outmigration of Orthopedic Patients from a Health System’s Patient Base
A 25-bed critical access hospital with 50+ employed providers and a strong regional presence was performing due diligence related to potential development of their own orthopedic program. To supplement their efforts, they desired a deep-dive analysis into outmigration of orthopedic patients in their region. The health system is geographically located in a region where patients have many options for healthcare services in a 30-minute radius and often cross state lines for services. Traditional market share has always proved inadequate as data was not easily shared among hospital associations and always lacked ambulatory service data. The hospital is closely aligned with a significant number of primary care providers in the region providing them touch points with most of the population base.
Measurement of patient Share of Care at the orthopedic service line, orthopedic procedure, and orthopedic provider levels was intended to identify most significant areas of patient leakage at each. Outcomes of analysis would be utilized to develop a patient retention tactics that supported their overall orthopedic service line development strategy.
HSG Patient Share of Care Process
- Service facilities were categorized into “In Network” or “Out of Network” entities as it related to site of service and alignment with the health system. Current orthopedic providers in the market were also category as “Aligned” or “Not Aligned” with the health system.
- All health system employed or closely aligned primary care providers in the market (≈40) were included.
- A patient cohort was created based on established office visits with any of the health system employed or closely aligned primary care providers.
- All claims associated with those patients were analyzed over a 2-year timeframe and rolled into an overall orthopedic service line with breakdowns by sub-service lines, orthopedic procedures, and individual rendering providers.
What HSG Found
For overall orthopedic services in the region, only 21% of volume was being provided at “In Network” facilities with 40+% of patient services being provided at tertiary facilities 30 to 45 minutes from the main hospital location. 59% of services going to tertiary facilities were for general orthopedic procedures and were categorized as incremental patient retention opportunities from the engagement. 41% of services to tertiary facilities were categorized as non-incremental opportunities as patients were leaving the market for specialized orthopedic services that the health system does not provide at their facilities.
The second highest volume of patient services (14%) were provided by a regional competitor with only moderate orthopedic coverage in the hospital’s direct service area and inconsistent orthopedic coverage overall. This volume was also identified as an incremental patient retention opportunity. HSG Patient Share of Care processes specifically discovered nearly 40% incremental patient retention opportunities for the health system. This data supported their plan to develop their own orthopedic program which is now in progress.
Measurement is planned to be ongoing to continually measure implementation success and redefine the service line strategy as needed.
APPLYING HSG SHARE OF CARE TO YOUR ORGANIZATION
HSG, leaders in physician alignment and integration, partner with health system leadership teams to understand strategic issues and executive-level questions about patient retention before recommending an approach based around HSG Patient Share of Care.
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