August 09 2019 Robert Lin

Network Referral Intelligence: The Low Hanging Fruit of Provider Growth 

The challenge:

Optimizing for provider growth is top of mind for healthcare executives. A recent Moody’s report cited that “Revenue pressures continue to overshadow expense saving initiatives. While the median annual expense growth rate decelerated to 5.7% from 7.1%, the annual revenue growth rate declined faster, to 4.6% from 6.1%.” Providers faced with significant revenue degradation from declining reimbursement rates, site of care substitution towards outpatient, and payer steerage are aggressively looking to offset this risk. Moreover, with external provider consolidation largely behind us, providers are now looking inward to find growth. One of these growth strategies is physician alignment – and referral intelligence is at its core.

Referral intelligence can mean the difference between providers staying competitive or failing. Consider the total cost of a patient care journey. Any out-of-network referral could cost an organization significant revenue, making referral intelligence analytics one of the most critical investments for providers today. Ironically, it’s also one of the lowest hanging fruits, if providers have access to the right data and actionable insights.

Today’s referral intelligence tools lack the right data to be effective:

Today’s referral intelligence tools struggle to bring together the data required to map patient journeys in a comprehensive and granular manner. They often rely on Inpatient state data that miss other settings of care, or payer specific contracts that could be missing any of the BUCA payers. This means more blind spots than data, leading to uncaptured revenue as well as physician distrust.

Next-gen referral intelligence is closer than you think:

Last month Clarify Health released several new predictive analytics solutions to address the critical challenges payers and providers face as they work to optimize patient care, manage risk, and improve outcomes, including a solution for Referral and Market Share Intelligence.

Clarify Health’s Referral and Market Share Intelligence solution drives top-line revenue and continuity of care, analyzing referral patterns not only for your physicians but across your entire market. Our data coverage unlocks enhanced visibility into volume flows, while our analytics platform allows for drill-downs to the procedure level. Physicians can finally understand the full patient journey, and at what points patients are leaking along the continuum of care. Physician and patient-level insights enable more productive, data-driven discussions that physicians trust. Moreover, your value proposition increases when working with physicians. Providing transparent, timely, and interrogatable data not only improves physician alignment but also enables you to get to action faster, addressing areas of opportunity and capturing more revenue.

Why work with Clarify Health for referral intelligence?

Data coverage: Clarify has the most comprehensive data set in the industry. While others rely on EMR ordering data, publicly available data, or market-specific payer contracts, Clarify Health has linked years of clinical and commercial claims data representing more than 160M lives. Our status as a CMS Qualified Entity gives us access to 100% of longitudinal Medicare Part A, B and, D claims data. So, we can tell you more completely and precisely where and why volume is leaving your system, and how you compare to competitors.

Actionable insights: Competitors often come with pre-defined visuals and reports. While these may be valuable in identifying some opportunities, they fail to reach the level of root-cause analysis. Clarify provides referral insights at the most granular level; this allows you to not only identify root-cause but take action to capture value.

Sophisticated referral logic: Clarify builds the full patient journey to provide visibility into downstream utilization. Our referral logic doesn’t stop after first order referrals – it builds in the second, third, and fourth order referrals. This allows you to identify where things first broke down along the referral chain.

Access to underlying data: Clarify understands that transparency into the underlying data and the underpinnings of the insight is critical. We have built dynamic drill-down capabilities on data grids that you can export. The data is yours to interrogate. Working with Clarify means greater transparency, ownership of data to use how you want, and analytics and actionable insights that become part of your daily workflow.

Expert team: We have an expert team of former healthcare strategy consultants, healthcare industry leaders, and clinicians that have come together with Silicon Valley engineers to bring you analytic insights that incite real change, and ultimately deliver ROI.

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