Experts agree that the business of healthcare has changed. In this decade, healthcare executives will face new challenges and market pressures that cannot be addressed be the same old strategies. They must adapt or be left behind. Motivated by both fear and a drive to succeed, they are choosing to take action – and they are starting now.We’ve worked with healthcare executives from networks across the country that have chosen this path and have succeeded. It is a journey of transformation that can seem daunting at first but promises real results. But we’ve also found that this journey is far less daunting once executives embrace a new data-driven mindset, and the knowledge and tools that accompany that new way of thinking.
This important work is the core of what will likely be looked back on as one of the greatest moments of transformation that our industry has ever known. This is a network evolution. This is a movement about becoming better at business, doing better for patients, and delivering better care.
The best part is that the secret to success isn’t so much a secret. It’s a methodical approach that’s been proven by high-performing networks.
Here are 3 things to know about adapting, evolving, and building a better network:
1. It starts with a fact-finding mission: Any well-planned journey starts with a clear understanding of the current state and the desired destination. Many healthcare executives looking to transform their networks want to leap into action. While that is a noble intention, action without information often has unintended and unfortunate results.
The most important fact to find first is the network’s patient leakage rate. In a recent survey of healthcare executives, 87% of respondents said that addressing high patient leakage rates were a top priority. Almost three-quarters of respondents reported that they’re losing 10-20% of their annual revenue due to patient leakage rates. However, almost one-quarter reported that they currently don’t track leakage and don’t understand where or why it occurs. This matters because knowing leakage rates and revenue loss is the first step to towards quantifying network improvement – and the journey moves upwards and onwards from here.
2. It’s a data-driven endeavor from start to finish: Inaccurate or incomplete data can make or break a network’s success—and is likely one of the underlying factors contributing to patient leakage today. Even with the best strategy, it’s impossible to have a data-driven strategy that is not built upon a single source of truth in a network provider directory. Relying on bad data is like asking for bad results, slower network growth, and lower amounts, or no amount, of shared savings. To make smarter, more data-driven decisions and get the best results, healthcare organizations must leverage provider data at the point of care, in the back office, and with front-end staff. That data must not only be accurate, complete, and trusted, but also accessible within existing provider and staff workflows.
For high-performing networks, the provider directory also becomes the data engine that precision guides patients through the network, matching them to the most appropriate, in-network specialist every time. A data-driven approach to guiding patients through the network empowers primary care physicians and their staff to make referral decisions based on objective criteria that is clearly defined and visible to those making the referrals. More importantly, they are making referral decisions that are precisely chosen for that patient – and the network, and aligned with network KPIs. That solid foundation of objective provider data in the directory, combined with business rules and logic, drastically reduces leakage, increases revenue, and improves patient satisfaction.
3. The network must stay data-driven forever: High-performing networks thrive on data. It fuels their decision-making at all times. They review their real-time dashboards on a daily or weekly basis, watching referral patterns, monitoring sources of leakage, and tracking KPIs like annual wellness visits and readmission rates. But most importantly, they translate those data insights into decisions and into real-world action that spans the network. Leveraging the synergistic power of data combined with action to make improvements quickly and efficiently is final stage of the network evolution.
But in reality, the evolution is never complete. It’s always in progress because high-performing networks continue to rely on data because being a high-performing network demands that they stay data-driven. They continue to learn, grow, and evolve to be the best network for patients, providers and the bottom line – and that’s what true transformation is all about.