How to uncover more opportunities in the ambulatory market
Ambulatory care is one of the fastest-growing segments of the healthcare industry. While many healthcare provider organizations have benefitted from investing ahead of this trend, the market remains ripe with potential. To capture this potential, healthcare organizations need the right market data to inform strategic planning.
In this guide, we’ll discuss the ongoing shift in care from hospitals to ambulatory care settings and explore how to use healthcare commercial intelligence to uncover more opportunities in the ambulatory market. With this guide, you’ll learn how to use data to understand trends in ambulatory care, identify new referral streams, and unlock intelligence about your competitors.
Understand the shift from inpatient to outpatient settings
In recent years, the healthcare industry has experienced a significant shift in the way care is delivered, with more and more services being offered in ambulatory settings. Take ambulatory surgery centers (ASCs) as an example. Data show that ASC surgical procedures increased by 20% from 2019 through 2021, while hospital surgical procedure volume dropped 7% during the same period.
So, how does this impact healthcare provider organizations? Well, for one, it means that they need to adjust their business models to accommodate the shift in care settings. Provider organizations that have traditionally focused on inpatient care may need to invest in outpatient services to remain competitive in the market.
Additionally, the shift to outpatient care has implications for the revenue streams of provider organizations. Inpatient care is generally more expensive than outpatient care, so providers may see a decline in revenue because of the shift. However, they can also benefit from increased patient volume in outpatient settings, which could offset any revenue losses. ASCs, for example, have a higher average margin than hospitals.
Data-backed method to grow referrals
Are you a healthcare provider organization looking to expand your patient base or understand where your patients are seeking care outside of your system? One way to do this is by reviewing referral data.
Referral data can reveal important insights into local referral patterns and help you identify independent, high-volume physician referrers to target for outreach. It can also provide valuable insights into network leakage, which occurs when patients leave your network for care. By analyzing this data, you can find important referral sources as well as areas where you may be falling short and develop strategies to retain more patients within your system.
So, where do you start? Begin by looking at referral patterns within your market. Are your patients coming from other healthcare providers, such as certain health systems or physicians? For example, if you’re a specialist in orthopedic surgery and you notice that a significant portion of your patients are coming from a nearby rehabilitation center — but not another — this could be a new referral source for you.
Similarly, if you notice that many of your patients are coming from a specific geographic area, you may want to consider targeting your outreach efforts in that area. By examining referral data, you can also identify which high-volume, independent physicians are generating the most referrals in your market and develop strategies to build relationships with those physicians.
Another key area to look at is the physicians within your system making referrals. Are they referring to other providers within your network, or are they referring to providers outside of your system? If they are referring outside of your system, it's worth examining why. Are there areas where you are lacking expertise or resources that are causing physicians to refer out?
Using referral data, you can look at the types of procedures or specialties that are most referred out. For example, if you’re a hospital system with a large cardiology department, but you notice that many of your patients are being referred out for electrophysiology procedures, this could be a sign that you need to invest in this area to retain more patients within your system. On the other hand, if a certain physician within your network is referring twice as many cardiology cases as colleagues, it may be an opportunity to expand the physician’s clinical expertise.
Understand ambulatory market volumes using claims
Claims data is another rich source of information for healthcare organizations to gain insights into the ambulatory market and discover new opportunities. By analyzing claims data, healthcare organizations can uncover trends in local procedure volumes, identify areas of growth, and make informed decisions about how to allocate resources. Let's look at how claims data is used to achieve this.
Using claims data, you can examine the types of procedures being performed in which ambulatory surgical centers (ASCs) and how many of these procedures are being performed. This information can help you understand the needs of the local community and adjust your services to meet market demand. You can also pinpoint geographic markets that have a high demand for certain types of procedures. In Florida, for example, procedure volumes suggest a particularly strong demand for musculoskeletal surgeries in the Fort Myers area based on the total volume of musculoskeletal procedures among ASCs in the state.
If there is a high volume of claims or an increase in claims for a particular procedure in a specific area, this may indicate a growing need for that service in that market. For healthcare provider organizations, this could mean hiring physicians who specialize in that procedure or opening a new ambulatory care facility within the market. Similarly, if you notice a trend of patients seeking certain procedures as outpatients rather than inpatients, you can adjust your services accordingly.
Unlocking data to understand your competitors
You can also glean valuable insights into your competitors using market data. By understanding their strengths and weaknesses, you can position yourself more effectively to uncover more growth opportunities.
So, what does this look like in practice? One way to gain insights into your local competitors is to look at their physician composition. This can give you a sense of their size and capacity. Do they have a broader or narrower range of specialties? How many physicians does the practice employ or affiliate with? By understanding your competitors' physician base, you can assess how well they are equipped to meet the needs of the local population.
You can also gain insights into your competitors' procedure volumes. Are they performing more procedures than you in certain areas? Which procedures are most popular among their patients? Which physicians are performing the most procedures? Using the Florida example, claims data show that within Fort Myers, the Center for Specialized Surgery captured the largest share of musculoskeletal surgical procedure volume, with more than 25% of total procedures.
Another key area to look at is network affiliations and referrals. Whom are your competitors partnering with? Do they have relationships with larger healthcare systems or academic medical centers? Where do they refer patients and from whom do they receive patients? Understanding these affiliations and referral patterns can help you assess the level of resources and expertise your competitors have access to.
What it all means
Healthcare commercial intelligence can be a powerful tool for healthcare provider organizations looking to uncover more opportunities in the ambulatory market. By using data to understand trends in ASC volumes, identify new referral streams, and discover insights about your competitors, your organization can gain a competitive advantage and drive growth in the healthcare market. For more information on how to identify new opportunities, check out these resources: