4 ways providers use healthcare commercial intelligence to support patients and grow business

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By Alex Card

It’s an exciting, disorienting time to be a healthcare provider in America.

Between lingering pandemics, emerging public health threats, flirtations with value-based payment models and shifting care fundamentals, it’s not always easy to get your bearings in this rapidly changing industry.

Whether you’re an independent physician or the head of a provider organization, your proverbial compass likely points toward three overarching goals: Improving patient outcomes, increasing revenue, and reducing physician burnout. Getting there requires knowledge of the territory—the patients, facilities, institutions, and other providers that make up the market.

Many providers navigate using real-world data—such as clinical results, claims, and billing data—which they leverage to make more impactful business decisions, understand potential market opportunities, and gain insight into the patient journey. These data can also support efforts to reduce physician burnout and help prevent staffing crises.

Let’s look at these use cases in closer detail and see how they support better patient outcomes and drive growth.

Claims data—your key to more confident decision-making

When providers need to know the who, what, where, when, why, and how behind any clinical encounter, medical claims data offer the inside scoop.

Diagnosis, treatment and prescription patterns can all be gleaned by examining the billions of claims produced by these events every year. From these patterns, providers can strategize for business development, more narrowly target their marketing efforts, and spot market opportunities.

For instance, claims data can make it easier to segment territories by facility size, ER bed volume or specific disease diagnoses. Claims can also be used to determine which physicians are treating which patients and where—useful information for provider groups seeking to close specialist staffing gaps, or for independent physicians seeking to expand outreach efforts.

On the marketing side, claims data can help prepare for conversations with hospitals, vendors, and other providers by painting a fuller picture of their business and their competition. Diagnosis and procedure claims can help providers identify experts in disease states who can support their organization and impart insights that can inform their discussions.

Imagination is the limiting factor here: Whatever questions you have about patients, disease states, facilities, and fellow providers, the answers are most likely just a claims analysis away. Of course, having the right analytical tools makes the job a lot easier.

Understand relationships between providers, payors, and facilities

Point-of-care decisions are heavily influenced by provider affiliations and the payors involved. To get ahead in the market, healthcare professionals need to not only understand who’s affiliated with whom, but also how strong those affiliations are.

A combination of claims data, regulatory data sets, and good old-fashioned research can help to map physician relationships across healthcare organizations, facilities, and payors.

With a little extra legwork—or reliable healthcare commercial intelligence—it’s possible to get a good idea of affiliation strength based on the history and context behind those relationships. This gives providers some insight into potential opportunities for partnership, investment, mergers, and acquisitions.

Referral patterns are also useful indicators of the relationships between providers and networks. By examining referrals to in- and out-of-network providers, you can spot sources of patient leakage and target the healthcare professionals or facilities who might be influenced to send referrals your way.

Shape your strategies around the patient journey

Every patient’s journey is unique, but that doesn’t mean those journeys are inscrutable.

Real-world data makes it possible to analyze the healthcare experiences of highly specific patient cohorts: Where and from whom they’re receiving care, what kind of care they’re receiving and the outcomes that care is producing.

With this information, you can create strategies to improve patients’ journeys. That might mean acquiring better patient-facing technology, expanding service lines, training staff on new or in-demand procedures, or identifying facilities with poor performance and allocating resources toward improvement.

More positive patient experiences lead to more loyal patients, which ultimately reduces network leakage, improves care outcomes, and boosts reimbursement.

Keep provider burnout at bay

Lastly, let’s not forget that great care outcomes and organizational growth are largely dependent on the physicians who comprise a practice or provider group. If your doctors are too burnt out to perform well—or if they’re fleeing for other practices or industries—your patients’ experiences and bottom line will suffer, too.

Providers are overwhelmed thanks to COVID-19’s lingering staffing shortages and patients’ return to routine in-person care. Healthcare commercial intelligence can lessen the burden by helping providers match their skills and expertise to patients’ needs, and identify opportunities for partnerships that can more equitably balance workload.

Real-world data offer providers insights into the patient cohorts who can benefit most from their specialization, making it easier to target and market to those patients. This ensures healthcare professionals are practicing at the top of their license and focusing on the patients who really need their services—resulting in fewer mismatched visits that ultimately require a referral elsewhere, and less time spent coordinating care across networks and payors.

These data can also be used to identify physicians by therapy area, experience, skill set and other criteria for staffing or partnership opportunities. Having a roster of reliable personnel who are well-matched to patients’ needs keeps workloads from overwhelming the physicians who you and your patients depend on.

Take the shortcut to market clarity

I’ve outlined how the right data can help providers make sense of the market—but raw data alone isn’t exactly a roadmap. You’ll need analytical tools and some know-how to turn that data into useful healthcare commercial intelligence.

The Definitive Healthcare platform brings together data, analytics, and expertise in a powerful, intuitive package, so you can spend less time parsing claims and more time planning and executing the strategies that support your patients and your bottom line.

Want to get hands-on with our healthcare commercial intelligence? Sign up for a free trial today.

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