How to expand services and find market opportunities

Consumer expectations of the healthcare delivery system have evolved in many ways: Trust, personalization, and convenience are just a few of the areas that healthcare consumers expect health systems to keep up with other industries.

But it isn’t just about what experiences healthcare consumers expect. It’s also about the current state of our healthcare delivery system—and the demand or mounting pressures to meet the evolving health needs of the communities and populations we serve. The care gap is often widening between primary and quaternary care, which can leave a system in a position where it must find growth opportunities or continue to see its margins erode.

Meeting those expectations—along with rising demands, inflated labor costs, and increased drug and supply costs—compounds a variety of operational, financial, and medical pressures.

Unfortunately, eroding margins have hindered healthcare delivery systems’ abilities to stave off those pressures and meet those expectations.

Through the art and science of great planning, provider organizations can open a window of insight to inform strategic planning and execution, which can lay the groundwork for relieving those pressures and exceeding those expectations.

The foundation of any effective healthcare market strategy should incorporate three pillars:

• Measuring market size and share
• Assessing patient healthcare utilization
• Understanding the competitive landscape

To develop these pillars and unlock the insights at their core, provider organizations will need to employ qualitative and quantitative data. Only with these insights can an organization effectively form and execute a strategic plan.

Let’s examine just how to accomplish that.

Measure market size and share

The first pillar, measuring market size and share, directly informs providers’ strategic priorities, resource allocation, and competitive positioning. This begins with calculating the total addressable market (TAM), or the revenue potential for a particular service line.

While calculating TAM is worth its own guide, its central premise involves identifying the number of unique patients in your market for a specific service line. Healthcare claims data can be instrumental in achieving this.

With TAM established, there are three core concepts to consider: market trend analysis, patient migration patterns, and provider volume trends.

• Market trend analyses in healthcare should examine historical data, current market conditions, and forward-looking indicators to track patterns in service utilization, where patients for a particular service line originate, and the demographic makeup of those patients.
• Patient migration patterns—that is, who the patients leaving your market are and where they go—can provide clues about patients’ priorities, the strength of your competitors, and potential shortcomings in your own service offerings.
• Provider volume trends should focus on your market share as well as your competitors’. More specifically, you should consider how volumes of high-value procedures compare across competitors in your market, the leading specialties of those competitors, and the top-performing care locations.

Building out these specific analyses will provide a clear view of your market, how it has changed, and how it may yet evolve. With these insights, you can begin to prioritize growth opportunities and set realistic strategic goals.

Assess patient healthcare utilization

Building on a robust market share and size assessment, assessing patient healthcare utilization provides a more granular view into your patients’ behaviors. For most providers, the key factors to understand are procedure utilization and patients’ access to various organizations and providers.

For a full picture of which procedural services patients are utilizing within a targeted service line, analyze the top 10 subservice lines by procedure volumes, average charges, and share of in-network patients. This will reveal which services have the highest impact on utilization volume and procedure share, as well as the potential financial impact of those services. Services with procedure shares considerably below the market average could indicate potential opportunities for focus and growth.

Determining access can feel like a guessing game, but it’s really a matter of making educated inferences backed by real-world data. Here are some datapoints to explore:

• Provider-to-population ratio, focused on specialists associated with a target service line
• Average time to schedule new or follow-up visits
• Referral completion rates (as well as no-show or cancellation rates)
• Average travel time or distance to the nearest facility for targeted services
• Percentages of in-network providers and out-of-network providers within a targeted service line

By understanding procedure utilization and patients’ access to those procedures, you can begin to identify areas of focus for your growth initiatives. Depending on your findings, that may involve a variety of efforts, from targeted outreach to certain patients or referral sources, to building a more robust digital front door to improve access, to hiring additional specialists to meet growing demands.

Understand the competitive landscape

Deep intelligence about healthcare utilization and access to care is essential to any market investigation. But you should also understand what the competition is doing and how they are positioned in the market.

Consider the leaders in your market and aim to answer these questions about them:

• What is their market share for the service lines or procedures your organization is targeting?
• What are their top-performing service locations?
• How have procedure volumes changed at their primary service locations over time?
• How have changing procedure volumes impacted their market share?

Again, claims data will be your key to unlocking the answers to these questions.

The most informative competitive intelligence doesn’t necessarily come from the organizations performing at the top of your market. Be sure to examine the competitors growing at similar rates to your organization, too.

With a full understanding of the competitive landscape, including the performance trends of market leaders and your near-peer competitors, you can further focus your strategic priorities, whether that entails a market capture strategy to increase your growth rate, an acquisition strategy targeting independent practices and providers, or a hiring strategy built around your growth targets.

What it all means

There are numerous ways to achieve growth in the healthcare market, and the most lucrative opportunities for your organization may be quite different than the ones your industry peers are pursuing. Before you can prioritize opportunities and build a comprehensive strategy, you’ll need the data and analytical insights to size your market, assess utilization patterns, and understand your key competitors.

Claims data, reference and affiliations data, population intelligence, and consumer behavior trends all deliver actionable insights into service demand and gaps in procedural utilization that you leverage to maximize the impact of your service lines, improve patient outcomes, and drive revenue growth.

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