Drive, Redirect & Retain Referral Pipelines with Claims Data

Drive, Redirect & Retain Referral Pipelines with Claims Data

In today’s data-driven world, mastering data utilization in healthcare is no longer a luxury, but a necessity. Along with internal data, one of the richest resources at a physician liaisons disposal is claims data. This data, when analyzed correctly, can provide valuable insights to healthcare providers referral patterns, patient demographics, market trends and more. Leveraging claims data can help physician relations teams to enhance their operations while establishing and retaining robust referral pipelines.

Understand Claims Data

Claims data is a treasure trove of insights, encapsulating several critical elements, including:

  • Procedure Market Analysis — Healthcare providers performing the most procedures
  • Referral Utilization Analysis — Patterns in how & how often providers are referring patients
  • Estimated Patient Origin — Possible patient locations based on prescription origins
  • Provider Payer Mixes— Balance between commercial & CMS in providers’ top insurance plans
  • Patient Demographic Info — Patient demographics & their referral trends

Working with extensive data sets like can lead to what is often called “data paralysis.” However, by harnessing intelligent solutions and engaging in relevant training, it’s easy to use claims data to your advantage to drive volume, redirect volume and retain referral pipelines.

Drive Referral Volume

Claims data can help you identify growing markets and specific service lines for targeted growth strategies. Take, for example, enhancing ENT referrals. By harnessing this data, physician liaisons can identify the leading providers, geographical hotspots and dominant referral trends. Combining this data with internal data allows the design of effective initiatives, like a “Providers to Watch” report, to expand the referral base.

Redirect Referral Volume

Claims data is your ally in identifying referral utilization gaps. Identifying these gaps enables physician liaisons to personalize their marketing and outreach messages. By categorizing provider loyalty levels and understanding their utilization of specific service lines, you can effectively steer conversations and collaborations with providers. This focused approach, backed by data, improves the quality of provider interactions and helps redirect patient volume towards your organization.

Utilization Metrics & Categories:

Strong: 76% — 100%

Reliable: 51% — 75%

Splitter: 26% — 50%

Weak: 0% — 25%

Retain Referral Volume

Claims data is an essential tool in recognizing and retaining strong referral pipelines. Comparing internal data with claims data lets physician liaisons validate their most advantageous relationships. Offering providers key insights and transparency can further solidify these relationships. Reports like “Top Referring Providers by Encounters” can also assist in refining retention strategies.

Partner with Marketware for Claims Data Utilization

Investing in comprehensive data sources, such as healthcare analytics, can provide returns that far outweigh the initial costs. By tapping into a broad spectrum of sources, payers and places of care, healthcare organizations gain a more holistic view of the opportunities present in their markets. Our data analytics platform exemplifies the value of this kind of resource with user-friendly dashboards that facilitate quick filtering and sorting of claims and PRM data. With these tools, team members can swiftly identify top providers by service line, procedural group, specialty, market, payer and growth initiatives, among others.

Get an Inside Look

Are you curious about how to use data to steer your physician outreach effectively?  Marketware’s Vice President — and former Marketware customer — Josh Cameron welcomes any questions at Let us help guide you on your data-driven journey in healthcare!

Data Driven Physician Outreach

Tool Kit — Healthcare Analytics

Data-Driven Physician Outreach

The leaders of today’s physician outreach teams will attest that data is the cornerstone for successful referral development initiatives. Learn what…

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Pair Claims Data with Provider Relations to Drive Referral Growth

Webinar — Healthcare Analytics

Pair Claims Data with Provider Relations to Drive Referral Growth

Provider relations is still 1 of the driving factors for growth. Pairing the efforts of your provider relations team with data can help your organization…

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Date: June 27 2023
Subject: Healthcare Analytics
About the author
Josh Cameron, MBA — President, Marketware
Josh Cameron, MBA

Executive Vice President

Marketware, a Division of Medsphere