Turning External Claims Data into Dollars

Turning External Claims Data into Dollars

Many healthcare leaders across the country understand the importance of data and many argue that data is one of the most valuable assets to their organization. Shantanu Narayen, CEO of Adobe, explains: “Data should ultimately be used to drive actions and support decisions that address the goals and issues of an organization. By making data actionable, your organization can grow beyond measure.” External claims data is especially important for health systems because it provides healthcare leaders the opportunity to view patient trends outside of their organization. Let’s address how translating data into ROI can be a key success factor for your organization. 

Why Healthcare Teams Are Moving Toward a Data-Driven Approach

Many healthcare organizations are utilizing external claims data to increase ROI. Without this kind of data, hospitals, health systems, and medical groups lack the insights needed to fully understand their referral base. This leads to unfocused or misdirected outreach, unreliable network connections, potential physician misalignments, and limited growth. Utilizing claims data to drive strategic plans supports the development of stronger strategic priorities, focuses outreach on what adds the most value and provides the foundational support needed to build and redirect referrals. This allows your healthcare organization the ability to measure and effectively communicate your outreach activities’ ROI.

At Marketware, a tool we give our clients to hone their data-driven approach is “The 8Ps of Data-Driven Development”:

  • Products that Perform: Which services are the most profitable in your organization?
  • Position in the Market: Where do you stand in the market compared to your competition?
  • Profitable Volumes: How can you focus on growing profitable volumes?
  • Patient Pipelines: How are patients directed to your organization?
  • Physician Alignment: What impact do formal/informal connections have?
  • Prioritization: How do you quantify & rank growth opportunities?
  • Planning for Progression: What actions need to be taken to advance relationships?
  • Proving Returns: How can you show the impact of your outreach efforts?
What Is External Claims Data?

In a poll completed by Marketware, 52% of healthcare organizations reported that insufficient data is the greatest challenge their organization faces. External claims data allows business users the ability to answer questions revolving around key competitors in specific markets and services. Claims data quickly and easily identifies both the top-performing providers and the top referring providers in your market. In other words, claims data identifies opportunities—and having a customized tool that provides and organizes data is a simple, user-friendly way to give you a holistic view of provider connections, opportunities, and threats.

The failure to understand claims data often results in limitations that negatively affect your organization’s use of claims data. External claims data offers approximately 70% capture (national average) based on a practitioner’s region. Therefore, healthcare claims data is meant to supplement your internal data sets, not replace them. This data is meant to provide directional analysis and referral connections insights. It is also important to highlight that financial projections from claims data is an estimate and each organization is unique. 

External Claims Dashboards: Your Data-Driven Strategy

External claims dashboards in Scout, for example, are designed to help you visualize and better understand your competitive landscape at the network, service line, provider, and procedural levels. The use of Scout’s procedural dashboard can uncover specific service lines and/or key competitors. After identifying key services lines and competitors, you can next identify key providers to target as potential referral partners. Your development team can also use the data to understand the providers tied to their direct competition and how to best influence these ties over time.

Effective analytics dashboards include flexible tools that provide customized data insights and views, provide competitor assessments, and are both drillable and interactive. Customizable tools also aid in deeper insight into market trends. 

Closing Thoughts

Many healthcare leaders recognize that data is important, but understanding how external claims data can result in direct organizational growth is imperative. Using a healthcare data analytics platform, your organization can answer specific questions about your market, identify new growth initiatives, and set your organization up for success. 

Interested in learning more? Schedule a free, customized demo of our growth suite!

Date: March 17 2020
Subject: Healthcare Analytics
About the Author
Jordan Smith — Brand Manager
Jordan Smith