Network Management and Design – PERFORM

Network Management – Reduce Leakage and Increase “Keepage”

EagleDream Health provides organizations with analysis of claims data identifying and delineating utilization of out-of-network resources.  Identification of these savings opportunities allows organizations to identify clinical services that might require enhanced access or improved communication in order to reduce revenue escape to out-of-network entities.  Network Management analysis, with geospatial mapping to the individual provider level based on paid claims data feeds, helps grow revenue by reducing referral pattern leakage to competition by as much as 30%.

Given the narrowing networks of healthcare delivery systems and the increasing importance of market share, EagleDream Health provides the necessary tools for tracking and reporting complex referral patterns and leakage, including drill-down to the financial impact of individual patient referrals.  EagleDream Health also provides health care delivery system leadership teams with an effective geospatial mapping tool to support data-driven decisions regarding strategic expansion of service lines, provider recruitment, and medical group practice M&A.  Further, given that patients are the most valuable asset to care delivery systems, EagleDream Health’s geospatial mapping tools help you retain the patient base of retiring and transitioning physicians (i.e. providers leaving the network).

The EDH Network Management application allows on-the-fly drill-down from aggregate network views to the individual practice, provider and even specific patient level to enable leadership to quickly determine in and out-of-network referrals, including each individual practitioner’s from/to referral relationships.

We analyze paid claims data and lists of in- and out-of-network providers to report what services remain in-network and what services get referred out, including the referring and referred-to practitioners at the individual patient level.  Geospatial mapping displays where practices are located to identify the extent to which geography may be causing leakage.  One can quickly learn who refers out most and least, to whom out-of-network referrals are going, and the dollars lost to out-of-network care.

These peer comparison reports provide the opportunity to explore why practitioners are referring out-of-network, enable an organization to incentivize in-network referral behaviors, and develop system-wide strategies to target specialties most in need of Network Management.  We estimate that systematically influencing physician referral patterns can lead to as much as 30% revenue re-capture (“keepage”).  No competitor offers an application designed to allow physicians to as quickly drill-down to their own actual individual patient referral data.

  • In and out of network referral patterns to be analyzed, reported, and managed across the defined network (leakage and keepage)
  • Geospatial representation of your entire network to identify, quantify and understand revenue escape to drive enhanced performance and remediation
  • Drill down capabilities from high level aggregate to individual patient and referring from/to provider views
  • Reporting of referral patterns by primary care practices and providers, by network, with drill down capabilities to individual provider and patient level detail
  • Reporting of referral patterns by “referred to” Specialties and providers by network, with drill-down capabilities to provider and patient level detail

Network Design – Geospatial Reporting by Network Layer and Specialty

The EDH Network Design tool presents geospatial mapping of internal specialist resources, primary care resources, and actual leakage (competitor) locations by specialty.  We analyze paid claims data on all attributed patients, allowing you to define in- and out-of-network practitioner relationships, and use geospatial mapping to quickly highlight gaps in practice placement and coverage by specialty.

Knowledge of out-of-network referral patterns, and especially geospatial mapping, identifies specialties and regions in need of attention.  This evidence informs strategic expansion plans, including where to add/acquire new practices or service lines, based on a graphical view of the entire network that includes plotting where competitive practices are located.  This helps your organization optimize the allocation of scarce capital for investment and/or network expansion.

  • Geospatial representation of your network with overlay of leaked to competitive entity locations
  • Multiple comparison views across groups, providers and the network
  • Trend reporting for referral patterns by network over time
  • Uniquely allows data driven decisions on practice placement and acquisition

PERFORM is our clinical variation and performance optimization module.