Patient journeys are inherently complex, but solving for them doesn’t have to be. As provider growth becomes a top priority for healthcare executives, mapping the patient journey is crucial to understanding how patients interact with the healthcare system along their entire continuum of care, and how well your organization is doing along each of those touchpoints. While attempting to capture all the various stakeholders, influencers, and touchpoints along the progression is no easy task, it really comes down to 5 key questions:

  1. How. How did patients enter into the system?
  2. What. What did patients need (i.e., what services and procedures)?
  3. Where. Where did patients seek care as they moved through different sites of care?
  4. Who. Who are these patients, and can they be grouped into logical cohorts?
  5. Why. Why did patients decide to seek care in your network vs. others?

If a provider can solve for these critical questions, the yield is significant in attracting and retaining customers, which can lead to clinical, organizational, and economic benefits. All five of these questions can be easily solved for using a patient journey framework.

1.    Identify the Trigger Event.

Defining what happens to start the patient journey is the first step. Once you identify the trigger event, you can start to build around it to determine upstream or downstream utilization. For instance, you can trigger off an inpatient stay (i.e., spinal procedure) to identify pre- and post- events surrounding the trigger event. Alternatively, you can trigger off an admitting diagnosis and follow the full “lifetime value” of a patient as you track their downstream utilization. Whichever approach you take, you now have a trigger event to then temporally track the events – entry points, sites of care and procedures rendered – that either surround that trigger or are a result of the trigger. This is the illumination of Questions 1 – 3 above.

2.    Build and Prioritize Patient Cohorts.

As mentioned in our previous blog post, it’s essential to keep in mind the low-hanging fruit. That’s even more critical here given the complexity of patient journeys. As you think about which patient journeys are worth mapping first, there are certainly cohorts of patients that generate more upstream and downstream utilization than others. For instance, patients that come in with an allergic reaction, on average, do not generate as much downstream utilization as those showing up with abdominal pain; therefore, the need to map the patient journey is greater for patients with abdominal pain. Ultimately, it’s valuable to identify these “micro-target” populations to ensure you’re focusing on the highest opportunity patients. This tackles Question 4 above.

3.    Go Beyond Mapping – Find Points Along the Map to Take Action. 

None of this is worth anything if you aren’t able to take action. While a lot of firms and vendors are starting to tackle the patient journey, few go beyond visualizing the journey, and most don’t dig into specific areas to take action. Areas of interest for organizations looking to make this possible should be:

  • the ability to drill-down into specific sub-service lines and techniques to understand exactly which procedures patients are seeking, by how much (measured in both volume and dollars), and where, to specifically pinpoint and quantify share of wallet opportunity.
  • understanding whether or not there was an influencer to drive these decisions (i.e., a referral made by one of your physicians or by a physician you could pick up). This is where it becomes crucial to overlay referral logic directly into the patient journey. You need the ability to understand which referring physicians are at critical points during the journey, as this an area you have direct influence over. We’ve now covered Questions 1–5! 

Answering these five questions effectively can mean the difference between providers staying competitive or failing, of attracting and retaining customers or losing them to other providers down the road. Considering the total cost of a patient care journey, any out-of-network referral could cost an organization significant revenue. Referral intelligence analytics one of the most critical investments for providers today – and it’s also one of the lowest hanging fruits if you have access to the right data and actionable insights.

What do we mean when we say you need the right data and actionable insights?

Stepping back, all of this could not be done completely and accurately without longitudinal data and without the highest degree of data coverage to ensure you’re not missing key blind spots along any patient journey. Many referral intelligence tools fail to bring together enough complete data to map patient journeys in a comprehensive, interrogatable, and granular manner. This means more questions than data, leading to missed opportunities and strain on physician trust. Without the ability to identify root-cause, physicians can’t take action to capture value.
To learn more about patient journeys as a key growth strategy, contact Robert Lin at [email protected] and check out our Network Referral Intelligence Solution Brief.