The powerful impact on market intelligence for healthcare providers

The challenge

Address declining revenue with competitive, patient, and financial insights

A leading healthcare system was experiencing declining revenue despite a growing population in their area. Addressing this issue demanded market intelligence that would allow them to analyze the area’s patient population, collect information on the competition, and make strategic decisions to reach and retain more patients.

To generate the necessary insights, the team needed to:

1. Understand the competitive landscape: They needed to size the market and gather key intel on their competitors’ service line offerings, diagnosis and procedure volumes, geographical footprint, financial performance, and clinical characteristics.

2. Uncover patient leakage: They needed to capture the patient journey including diagnosis origination, procedure history, and out-of-network referrals to understand where the network was losing patients.

3. Identify the greatest financial return: They needed to identify which service lines would bring in the highest patient volume and generate the most revenue.

As the team began their analysis, they looked to a trusted data source to base their strategic revenue generating decisions.

The solution

Unlock market intelligence to power an effective, strategic plan for financial recovery

The healthcare system was already familiar with Definitive Healthcare as a user of HospitalView. The team knew they could leverage the product’s core based statistical area (CBSA) Market Overview, IDN/Hospital search, Report Builder, Hospital Analytics, CBSA profiles, and IDN/Hospital profiles to gain a complete picture of their region’s patient population, providers, and Medicare claims volumes.

Because they needed current and comprehensive visibility into diagnosis and procedure claims in order to inform their strategy, the team adopted an additional element of the Definitive Healthcare product portfolio, specifically ClaimsMx, to integrate with HospitalView, which they were already using. The addition of medical claims expanded the depth and breadth of insights across all age brackets, and with ClaimsMx ACE Projections, which estimates 100% claims coverage, they had unparalleled visibility into their market.

With HospitalView and ClaimsMx integrated into a single platform solution, the team gained a comprehensive view of the market, enabling them to:

1. Analyze the competitive market: The team used HospitalView to gather information on their competitors like total patient revenue, affiliations, and historical financials. With the addition of medical claims, they also were able to pinpoint the procedures with high patient volumes, charges, and year-over-year growth in their CBSA, and where their competitors stood within that space.

2. Find points of leakage: With a new understanding of the highest procedure volumes in the region, the team analyzed the patient journey related to these procedures within their own network. Using ClaimsMx, the team mapped where patients were seeking care. They also tracked referral patterns and identified which of these procedures had high out-of-network referrals. These analyses clarified specific action items about what needed to be done to retain patients.

3. Determine the greatest opportunity for growth: From these analyses, the team identified orthopedic knee surgery as a key area of growth. There were high volumes of these procedures done in the area; however, despite the network having hospitals, surgery centers and physician groups, their physicians were referring patients out-of-network, and patients were seeking care at their competition for not only the procedure, but for follow-up appointments as well.

The impact

Recaptured market share and revenue growth

Using the robust combination of HospitalView and ClaimsMx intelligence, the team developed and executed an informed strategic plan to recapture market share and accelerate revenue growth.

This plan featured:

1. Increased procedure claims volumes and margins: The team developed and executed a plan to expand their knee surgery services, hired surgeons who specialized in this procedure and educated their physicians who were referring out of network.

2. Greater market share: With a deeper understanding of the competitive market, the teams were able to recapture market share from their competitors and increase revenue by expanding patient reach and increasing patient retention.

3. Improved productivity: Both the analytics and market intelligence teams had access to market intelligence in one location, which saved them time and energy that was previously spent researching and consolidating incomplete data from disparate, public sources.