As provider growth becomes a top priority for healthcare executives, patient journey mapping is crucial to understand how patients interact with the healthcare system along the entire continuum of care, and how well each care organization is doing along each of those touch points. It is also important to understand physician alignment and healthcare market trends when looking for strategies to grow your business.

Patient journeys are inherently complex, but analyzing them doesn’t have to be. Understanding the patient healthcare journey 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 service lines and procedures)?
3. Where. Where in the patient healthcare journey did patients seek care as they moved through different sites of care?
4. Who. Who are these patients, what is the patient profile, and can they be grouped into logical patient cohorts?
5. Why. Why did patients decide to seek care in your network vs. others?

If a provider can answer these questions with speed and precision, the yield is significant in attracting and retaining customers. 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 healthcare 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 patient cohorts 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 patient cohorts to ensure you’re focusing on the highest opportunity patients. This tackles Question 4 above.

3.    Go Beyond Patient Journey 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 vendors offer utilization or cost benchmarking, few are have tackled the patient journey, and even fewer 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 referral patterns and whether or not there was an influencer to drive these decisions (i.e., a physician referral made within your network 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 who the referring physicians are at critical points during the patient journey, as this an area you have direct influence over. We’ve now covered Questions 1–5! 

Answering these five questions about patient journeys effectively can mean the difference between providers staying competitive or failing, attracting patients or losing them to other providers, and service line growth or contraction. Considering the total cost of a patient care journey, any out-of-network physician referral could cost an organization significant revenue. Referral analytics and market insights are two of the most critical investments for providers today – and they’re also one of the lowest hanging fruits if you have access to the patient insights.

What do we mean when we say you need patient 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 and market analytics fail to bring together patient data sets that are large enough and complete enough to map patient journeys in a comprehensive, interrogatable, and granular manner. This means more questions than patient insights, leading to missed opportunities and strain on physician trust. Without the ability to identify root-cause, physicians can’t take action to capture value. Click here to learn more about how Clarify helps providers grow strategically and achieve higher value care.