Physician Market Share Data: Where it Comes From & Why it Matters

Physician Market Share Data Where it Comes From & Why it Matters

Access to physician market share data is quickly becoming less a commodity and more an essential component of a physician relations program. Dr. David Zirkle, an expert in physician relations with Barlow/McCarthy, affirms that “market share data is the one sure-fire way to assess your organization’s performance relative to competitors in the marketplace.”

Though data can work magic for a physician relations department, it doesn’t appear out of thin air. Knowing where data comes from and how it works can give valuable insight on how to really leverage this asset to your greatest advantage.  

Where Physician Market Share Data Comes From

For starters, physician market share data comes from insurance claims data. There are 2 types of claims data:

  • Internal claims data — which is derived from patient interactions within your hospital or healthcare facility
  • External claims data — which is derived from patient interactions happening at all facilities outside of your hospital

Internal claims data can generally be accessed through your own data resources (accounts payable/receivable, intake, etc.), while external claims data is what you want to take a closer look at to see market share and referral behavior. But how is it obtained?

It all starts with a patient going to the doctor. After this patient leaves the office, insurance forms containing information on the visit and any referrals are stored in a practice management software system. These documents, like CMS1500 or 837 forms, are then sent to data clearinghouses, where they accumulate in a large data storage system. Payers prefer to receive claims in bulk so that, rather than repeatedly sending smaller individual payments, they can pay providers in large conglomerate sums. Once these claims have accumulated to a certain number, they are then processed and payments are issued.

The data clearinghouses offer private companies the option to purchase the bulk data after it has been “de-identified”. In other words, all the information that could trace the claim back to the original patient is removed (such as name, social security number, date of birth, etc.) What remains is a holistic view of patients’ interactions with the health care system within a particular region. Most importantly to those working in physician relations, it gives accurate figures on physician referral patterns.

How it Works

When it is purchased from a clearinghouse, data is more or less an enormous cache of physician names and numbers. Some of these files are so large they can’t be opened by most computers or Excel applications. In a spreadsheet they span thousands—and in some cases—millions of cells down and across. In its raw form, claims data is not very helpful.

In order to really make use of claims data, you need to import it into a business intelligence program specifically designed to handle this type of file. Once imported, a BI program (like our data platform) is able to sort this data into figures and graphs that give you a clear idea of referral behavior among physicians throughout your region.

For instance, you might see that Dr. Lee, an independent primary care physician, refers about 65% of his cardiology patients to you. But the data also shows that he is sending the remaining 35% of his patients to an out-of-network facility. Studies show that 66% of all referrals are based on the physician’s preference—perhaps Dr. Lee is unaware that your hospital has the specialties needed for those patients, or perhaps he personally knows the specialist he is referring to.

Dr. Lee would be considered a splitter (a physician that “splits” his referrals between your organization and your competitors’), and due to the information provided by your analysis of the claims data, you can figure out a strategy to reach out to him and see how you can acquire the other 35% of his patients. A physician liaison could educate him on the hospital’s range of services and procedures, clear up any issues, and introduce him to some of the specialists working at the hospital. Data also helps organizations retain referrals from “loyalist” physicians, and its 360° view of the industry makes it possible to strategically seek out and explore new markets and opportunities for growth.

Over time, you can demonstrate the ROI of outreach efforts by showing the increase in referrals through both internal claims data (what’s going on within your own facility) and external claims data (everything going on around you). Most importantly, claims data provides a clear view of physician referral behavior that translates into actionable tasks and initiatives, leading to a solid strategy for growth.

See how Marketware’s data and analytics platform can help you better understanding physician market share data and how you can use it to demonstrate your ROI. Schedule a customized tour of our physician strategy suite today

Date: March 17 2021
Subject: Healthcare Analytics
About the Author
Amanda Houchins — VP, Sales
Amanda Houchins

VP of Sales