Network Optimization & Healthcare Consolidation

Healthcare Business Development Opportunities to Deliver Value Through In-Network “Keepage”

The terminology varies: care retention, leakage mitigation, network integrity, referral management. But the goal is the same: achieve strategic growth goals and population health outcomes by keeping business, especially from employed physicians, within your system whenever appropriate and available. A data-driven, well-structured strategy – implemented by a well-trained team – is guaranteed to reduce network leakage.

Achieve Healthcare Strategic Growth With An Integrated Approach to Change

We will help you discover and remove barriers that contribute to network leakage and achieve better alignment between your primary care practices, affiliated or employed specialists and key service lines within your organization. This requires greater focus and collaboration to help them understand and embrace the value and importance of their role in guiding patients within your network’s continuum of care.

Building care pathways for the right care in the right settings and at the right cost supports all care models, including traditional and value-based reimbursement. The laser-focus on strategic growth also supports volume in key services lines, such as Cardiology, Cancer and Neurosciences.

Our four-phased approach to network optimization and care consolidation includes:

• Strategic Assessment
• Referral Data Analysis
• Strategy Development
• Execution

Strategic Assessment

A thorough quantitative and qualitative assessment often reveals misconceptions surrounding the root causes of leakage and identifies millions of dollars of out-of-network utilization opportunity.

We conduct comprehensive surveys and selected one-on-one interviews with primary care and key specialty physician practices, as well as service line operators, population health managers and leadership, and many other key stakeholders.

Referral Data Analysis

Our data analysis integrates siloed referral data and payer claims to produce network utilization reports at the service line, facility and physician levels. Sharing our robust – and sometimes eye-opening – assessment and data reports with stakeholders enables them to assume greater accountability for guiding care consolidation. However, data is not the silver bullet. Without a sound strategy and effective execution, greater risk of disruption and disengagement can emerge.

Strategy Development

Working with leadership, we develop data-driven care retention strategies to stop outmigration. Simply put, we help identify ways to make it easier for physicians, their teams and patients to access the right provider and setting to achieve the best outcomes.

The resulting action plans are laser-focused on physicians and schedulers onsite with the highest opportunity to improve in-network referral patterns. The strategy focuses on optimizing the referral process, expanding access and capacity, enhancing the patient/provider experience and ultimately improving outcomes.

Execution

Deployment of the outreach team to execute care consolidation strategies is supported by referral tools and resources that enable them to build awareness, collect market intelligence, manage issue resolution and provide feedback and actionable information to leadership, physicians and their teams.

The strategies set a course for the team to:

• Launch access to care initiatives in the primary care practices and expand these initiatives to specialists
• Execute a care consolidation outreach program – staffed by physician liaisons and population health managers
• Collaborate with service line leadership to create disease-specific care pathways
• Optimize referral workflows and reporting
• Work as partners to align the marketing team in developing collateral and marketing campaigns