Network Integrity is the ability to keep patients within the organization-defined provider network and can optimize your hospitals financial and operational performance. In our last article and video, we covered the basics of patient loyalty and network integrity. In this video we are going to look at how a healthcare system in Virginia incorporated network integrity leading to improving patient loyalty.
Meet VHC Health
VHC Health, located in Arlington, VA, 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. VHC Health started with primary care. VHC Health 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 VHC Health primary care provider. This first data dive established VHC Health’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 VHC Health with which individual primary care providers were “loyalists” or “splitters.” Their loyalists followed the patient from the provider to the specialist and those providers that shared 75% or more of their patients with a VHC Health community provider. Splitters were those providers that had more outmigration, and their patients were split between VHC Health and other health systems or providers.
VHC Health focused on the splitters from their market share analysis, as splitters are more likely to convert patients back to VHC Health versus the providers that did not have any shared visits with VHC Health. Once the splitters were identified, VHC Health focused on understanding what referral patterns existed.
Understanding Patient Service Areas
VHC Health also wanted to understand where patients were choosing to have their care in the primary and secondary service areas. One area of focus was ambulatory surgery centers. VHC Health started with claims data pulled from patients living in zip codes in their primary and secondary service areas, the procedures the patients had, the provider rendering the service, and the billing provider that included total charges. The data was then 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 VHC Health 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 VHC Health that management might want to consider adding and leakage of procedures that could be done at VHC Health.
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. If your healthcare organization has any questions or would like to learn more about improving patient loyalty and how Blue & Co. can help, please reach out to your local advisor or one of our experts below.
