The 4th Annual World Congress Physician Liaison Summit Midwest took place last month in Cleveland. Like-minded physician referral management experts and physician liaisons joined forces for two days to put their heads together around physician relations. Tea Leaves Health had the privilege of attending and presenting at the conference. Here are a couple of learnings we walked away with.
There is still a lot of mystery around claims data and where it comes from.
Here’s a quick breakdown of what happens to a health insurance claim after it’s been submitted:
First, the claim is routed to the appropriate parties to collect payment, and is eventually paid. Then all of the data in the claim goes into a claims database. That data is then pulled into an organization’s CRM/PRM database, where it’s combined with physician and encounter data.
Many organizations tend to think claims data is the end-all-be-all for physician relations. Before we can go on to explain what claims data is, we should touch on what it is not. It’s not raw claims, it doesn’t go down to the patient level, it isn’t financially-based and it is not 100% complete.
Claims data really only covers 70-80% of claims and should be viewed as an enhancement to internal data. It simply provides an organization more direction around a physician’s volumes, influence networks, payer mix and procedure mix.
Organizations with CRM/PRM systems can use the claim data to positively impact market share.
Here are some examples of how claims data and CRM/PRM software can work together to provide insights that can be used to gain more market share:
- The system can show you areas of leakage, or inversely, keepage. It can show you which employed PCPs are referring to non-employed/staff cardiologists as well as which cardiologists are referring to non-employed cardiovascular surgeons.
- You can reference the CRM/PRM system to get a glimpse of your referral networks. For example, you can see which community PCPs are referring to your employed oncologists, or which unengaged PCPs are referring to competing orthopedic surgeons.
- You can review your service line market share – the total number of unique patients, by service line, in your market area. You can also look at who your physicians are, and their individual volumes by affiliation.
With that information, you can work to re-engage the PCPs who are referring to competitors and encourage them to refer within your network, thus ultimately increasing your market share. To improve physician relations within your organization, simply be sure to use all the data available to you. Contact us if you’re interested in learning more about this topic or about our physician referral management solution, Physicianology™.