If You Refer Them, They Will Come

  by Tara Gallagher

Health care organizations are currently trying to identify opportunities for enhanced revenue streams as they continue to struggle financially due to the COVID-19 endemic—hospital margins are expected to remain below pre-pandemic levels, with more than half of hospitals projected to have negative margins.

And health care leaders have long understood how patient leakage also dramatically affects the bottom line: out-of-network referrals can cost organizations $200 to $500M per year. Which is why physician network optimization can be a powerful way to support both a healthier bottom line for your organization and more seamless care coordination for your patients.

Physician network optimization initiatives are increasingly vital to a health care organization’s sustainability. To fully understand physician leakage, hospitals need analytic tools that are not only built with maximum visibility into all markets, but also quantify leakage in terms of both volumes and dollars. And insight into physician leakage volumes in the outpatient setting only tells half the story—referral patterns must be analyzed across all sites of care and all financial classes, as well as by clinical category, to fully understand leakage.

Introducing Provider Connections…

Thus, Sg2 is excited to announce the release of Provider Connections. Our newest analytic tool is designed to help business development and physician outreach teams understand physician business patterns in local markets, prioritize physician outreach efforts and execute physician network optimization initiatives. Provider Connections can also add robust data intelligence to your existing provider relationship management (PRM) solution.

Provider Connections can help your organization answer these questions:

  • How strong are the current business relationships within my physician network?
  • Which service lines present significant mid-and-downstream volume and revenue potential?
  • What is the financial impact of leakage on my organization?
  • Which practices and individual physicians should I prioritize for outreach efforts?
  • How can my organization measure the effectiveness of physician outreach efforts?
  • What is the opportunity to recapture business in network from my affiliated physicians over time?
  • What does splitter behavior look like in my market?

Of course, building a new tool designed for a new audience of business development teams and physician liaisons requires a more robust claims data set. To meet this need, Sg2 has dedicated time and attention to understanding, ingesting and integrating multiple payer-based (closed) and provider-based (clearinghouse) claims data sets to create our best-in-class, all-payer claims data set with expanded visibility into all markets, care settings, providers and financial classes. Our new claims warehouse will support new data-enabled solutions to build and retain system loyalty, as well as further develop our existing claims tools, Ambulatory Market Strategist and Patient Flow.

Sg2 members can learn more about Sg2 claims data and claims data solutions in our recent post Shining a Light on Sg2 Claims Data.

Why We’re Excited About Provider Connections

Optimize Network Integrity and Achieve Short-term Growth

Provider Connections is the foundation of a successful physician loyalty initiative, helping your organization optimize your physician network and drive physician engagement and loyalty through insights into your market’s referral patterns. This tool can help your organization uncover its greatest areas of opportunity to grow volumes and gain revenue lift.

Promotional image for Provider Connections showing screenshots of the application. The text on the image reads: With approximately 60% of physician referrals going out of network, patient leakage can cost organizations 200-500 million dollars per year. Insights from our robust all-payer claims database, including the industry's largest complete patient journey longitudinal claims data set. Find and execute on specific service line revenue capture opportunities, improve physician network integrity, quantify financial impact of leakage, and prioritize physician outreach planning.

Provider Connections allows health systems to:

  • FIND: Provider Connections provides market insights and an understanding of physician referral networks to help your organization prioritize the right physicians for targeted outreach.
  • GUIDE: Provider Connections utilizes claims analytics and market intelligence to identify actionable insights for focused messaging for your outreach efforts, helping to drive physician engagement and improve physician business alignment.
  • KEEP: By leveraging data to target the right physicians, Provider Connections helps organizations encourage physicians to stay engaged with your health system, which, in turn, helps keep patients coming back to the health system as well.


Add Robust Data Intelligence to New or Existing PRM Solutions

A circle inside a network of connected lines and dots, illustrating the Physician Relationship Management (PRM) Solution that uses Sg2's robust data intelligence.Physician relationship management tools are utilized today to plan, track and measure the effectiveness of physician liaison activity across key growth initiatives. A full PRM solution not only requires a physician liaison tracking tool, it also requires robust claims data to provide physician leakage insights not just for providers within your organization, but for all providers in the market.

As previously mentioned, Sg2’s new claims data warehouse will fuel the data used in Provider Connections, making it the most comprehensive of its kind—displaying detailed leakage patterns by provider, clinical detail (CARE Family and Procedure) and location of service. The breadth and depth of data analytics in Provider Connections is the intelligent analytical engine that optimizes deployment of your business development resources.

  • Largest warehouse of robust claims data to feed PRM solutions: Provider Connections provides the most comprehensive engine to feed your PRM initiatives, representing over 200 million unique patients annually, which is roughly 70% of the total insured population nationally.
  • Easy to use application that is tablet enabled: The Provider Connections app can be found on the Sg2 Analytics platform and is tablet-friendly—specifically designed for the workflow of physician liaisons and business development teams.
  • Leverages financial modeling: Provider Connections allows your organization to better visualize leakage in terms of both volumes and dollars, which helps you quantify your revenue opportunity.


New Challenges Mean New Tools and New Data

Pandemic and post-pandemic market activity points to the need for a fundamental reframing of near-term growth approaches to combat financial pressures, emerging competitive disrupters, and shifting consumer and physician expectations.

Provider Connections is just one solution in a new suite of Sg2 tools and managed services that will help organizations realign and activate strategic near-term growth to meet today’s new growth imperative. Called Consumer Innovation, this suite of Sg2 data analytics and action-oriented service offerings helps your organization collaboratively plan and activate growth across operational, marketing and sales functions—enabling you to drive rapid and impactful growth while improving the overall consumer and physician experience. Please stay tuned as we continue to work toward helping you improve your growth strategies!

If you are interested in learning more about Provider Connections, please contact us at learnmore@sg2.com.

Sources: Kaufman Hall. The Current State of Hospital Finances: Fall 2022 Update. September 15, 2022; Leventhal R. Report: Healthcare execs worried about patient leakage, lack tools to improve. Healthcare Innovation. October 14, 2020; Mehrotra A et al. Milbank Q. 2011;89:39–68.

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Tags: claims data, growth, patient leakage, physician leakage, physician network, physician relationship management, PRM, Provider Connections, splitter behavior