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Apr
28

The Need for Combining EMR Data with Claims Data

Posted April 28, 2015

Growing uncertainty with healthcare reform, mounting pressures of running a practice, general dissatisfaction among physicians, CEO concerns about physician alignment – sounds like a recipe for disaster.   Enter physician relations – a role that has become increasingly more critical and strategic than ever before.   In order to generate the greatest response and influence with physicians and CEOs, liaisons need accurate, comprehensive, inclusive and timely data, at their fingertips.

“Hospitals do their best with data they collect to analyze growth opportunities and strengthen relationships with physicians, which is tough to do without a robust, effective business intelligence platform and a team of professionals to back it,” says Lori Brenner, EVP at Tea Leaves Health, and chief architect of PhysicianologyTM.

“The greatest challenge I faced as a liaison and a physician relations director was getting all the data I needed in one place. I had one source for Electronic Medical Records (EMR), another for state data, multiple physician databases all with their own physician IDs, and a separate application for contact management. How could I possibly show the wins I was gaining in the field with this lack of coordination? At Tea Leaves Health, we developed a single sign-on application that combines all available physician data including data from multiple EMRs, best in class claims data, and contact management sits at the core”.

It is essential to include your EMR data in a PRM solution for two key reasons:

  1. Claims data is incomplete. Even the best source includes at most 80% coverage per market
  2. EMR data shows what is happening inside your walls, which is where you are trying to drive volume.

While claims data is an excellent enhancement to your internal data, it is not a silver bullet. We counsel our client partners to use claims data for directionality, understanding if and how much a physician splits; identifying potential referral patterns between physicians; finding opportunities for service line growth by analyzing affiliations and utilization. Incorporating your EMR data allows you to precisely track and measure the affect your actions are having on the service lines. Did you convert a physician from unengaged to engaged? Are you seeing an upward utilization trend since you implemented the Action Plan?

A typical example: Our strategy team worked with a large, multi-hospital system to find the primary care physicians (PCPs) who were referring to specialists for a particular service line. We looked at the PCPs current affiliations, and referral volume to determine where we could drive more loyalty to the specialists. We worked closely with the liaison team to formulate a targeted list, and applied a focused Action Plan for the PCPs. By closely monitoring changes in EMR encounter volume and referral patterns of the specialists, we were able to attribute service line volume growth to the PCPs with which we were working. “We would not have been able to do this with claims data alone”, Brenner added.