In Brief
By Annie Zilius, Martin Bloomenkranz, and Scott Brown
Summary
- Physician referral decisions influence consumer choice and need to be well understood to create a complete view of a healthcare organization's network integrity and share of care.
- Improving network integrity requires effectively applying patient, consumer, and broader market data and insights across the entire continuum of care.
- Customer relationship management (CRM) platforms powered by data and paired with the right operating model can change how organizations interact with physicians and consumers to prevent network leakage and drive volume.
How Healthcare Organizations Can Build the Foundation to Avert Network Leakage
In healthcare, consumer loyalty continues to soften despite reports of high satisfaction. Huron’s consumer research finds that more than half of consumers are willing to switch providers.
As healthcare organizations seek to understand their market from the point of view of the consumer, understanding the impact that physician referral decisions have on consumer choice is crucial to creating a complete picture of network integrity and the share of care.
While consumers have more choice in where they receive services, the physician’s referral remains the primary driver for where patients will go next for care. Robust provider relationship management programs deployed in tandem with direct-to-consumer strategies enabled by data, technology, and analytics are essential in today’s competitive market.
While CRM platforms have not traditionally been a mainstay of the healthcare organization technology ecosystem, they have become more valuable to how healthcare operates.
Huron’s research finds that more than a third of healthcare organizations are planning investments in CRM technology. Most report CRM will be used to improve care access, physician experiences, digital front door capabilities, and the overall consumer journey.
Building the Technical and Operational Foundation
Data is instrumental for healthcare organizations seeking to improve consumer and physician relationships. However, data can only be actionable with a CRM that enables staff, physicians, and consumers to engage in more timely and effective communications.
The first step must be to shore up the foundation and build modern, consumer-centric access operating models that create the capacity to fulfill referrals and the consistency to scale across clinical specialties.
Once the foundational components are in place, organizations can scale and more nimbly implement innovative solutions that increase consumer access and improve physician referral management.
Elevating Network Integrity
Even when an organization’s access operating model or systems are at their best, internal data is still insufficient to reveal vulnerable network leakage points or opportunities for growth.
While healthcare organizations can see patient volumes and charges coming into their network, what organizations should be asking is: How many patients are not showing up because they are going to competitors? The only way to know with certainty is to have access to broader market data enabling leaders to measure local physician networks and financial relationships fully. There are also many related use cases for how predictive consumer data is changing how healthcare operates.
Addressing network or referral leakage requires understanding the entire continuum of care. By looking at relationships between sites of care and how patients are moving through the community based on their conditions or procedural needs, organizations start to understand the financial integrity of their network. That point of view depends entirely on getting data from outside the organization's four walls.
Driving Market Capture
Improving network integrity requires applying market data and insights effectively to understand where patients come from and where patients are being sent for follow-up after receiving care from the organization. Segmenting patient migration patterns by physician, specialty, and procedure type helps prioritize which relationships to pursue in network integrity efforts.
Market insights can also help leaders understand where transitions of care (e.g., inpatient discharge) influence financial and quality outcomes such as avoidable readmissions.
From there, organizations can begin to innovate and utilize CRM platforms to manage and use data in actionable ways that drive growth and demand capture.
Getting the Job Done With Salesforce
3 Ways Salesforce Is Alleviating Network Leakage
Organizations are making significant strides in consumerism and physician referrals with Salesforce solutions. These solutions hold the key to making data actionable.Below are three key ways Salesforce and Salesforce Health Cloud are transforming physician referral management programs by leveraging data within the tool.