Three Rules for Measuring Physician Market Share

Transcription

1 Crimson Market Advantage RESEARCH BRIEFING Three Rules for Measuring Physician Market Share Research and insights Performance Technologies Consulting and management Talent Development

2 new definition Hospitals require a of market performance For much of the last decade, utilization and price growth encouraged organizations to pursue growth tactics singularly focused on high-margin, high-volume, primarily inpatient procedures. Measuring market share for these services therefore became the best way to evaluate competitive position. Such a view of market share will prove too limited in the new health care economy. Most hospitals and health systems now operate in environments where inpatient utilization and price growth have slowed. Purchasers of all kinds continue to push back against questionable utilization and reclaim pricing leverage. A strategy focused solely on growing profitable volumes will prove less and less viable over time.

3 Market share assessments must reflect new market strategies To grow in this new environment, healthcare provider organizations will need to compete not as hospitals but as integrated health systems that work seamlessly with physician partners to meet patients needs across the continuum. Your market share assessments must therefore be more sensitive to these goals. Three Imperatives for Market Share Assessment 1 Measure system performance rather than hospital performance Future acute care growth will require hospitals to compete upstream for patients and populations. Providers must measure share beyond acute care at all points in the continuum. 2 Measure physician network strength rather than just facility strength Your ability to compete as the health system of choice will be only as good as the integrity of your physician network. Closing specialist leakage points will continue to be critical, but you must also measure your share of primary care the new locus of control for provider selection. 3 Measure individuals rather than clicks The race is on to lock in patients to preferred networks. Whether you are a population manager or you are competing against population managers, future competitive position will be won or lost on patient loyalty. You must measure your ability to meet patients needs across the continuum, rather than just for specific points of service. Three Rules for Measuring Physician Market Share 1

4 Expand your view of market share to include three critical categories Your new health system ambitions require a market share model that provides a more integrated view of overall health system economics. The Advisory Board s Total Share model first measures an institution s share of all health spending in a given market. Total revenue share can then be examined in three ways the services provided in the market, the physicians ordering those services, and the patients receiving them. This model improves on the traditional approach to market share in two ways. First, as you compete more for patients and populations across the continuum of care, the Total Share model helps you better measure system performance across different settings. Second, Total Share enables greater sensitivity to purchaser, physician, and patient decision making all direct drivers of service share. Read on to learn about the most important rules of the road for looking at Total Share. 2 Crimson Market Advantage

5 The Total Share Model Illustrative Example All Health Care Spending 26.8% Your Payments: $128M Market Payment: $478M Service Share Physician Share patient Share 27.1% 20.4% 14.9% Your Volume: 84,000 Market Volume: 309,895 Physicians Affiliated with You: 2,525 Physicians in the Market: 12,385 # of Patients with You: 6,933 # of Patients in the Market: 46,534 Traditional View Expanded View Three Rules for Measuring Physician Market Share 3

6 Physician Share Physician share tells you the percentage of physicians you work with in the market, as well as the strength of those relationships. Physician share is a critical component of your total market share picture because it allows you to measure physician choice one of the direct drivers of service share. In addition, physician share gives you information essential for managing the integrity of your physician-driven enterprise. Key Metrics Specialist Share Number of specialists in the market Percentage of specialists connected to your organization Average revenue per specialist Revenue leakage per specialist Primary Care Physician Share Number of PCPs in the market Percentage of PCPs connected to your organization Average revenue per PCP Revenue leakage per PCP PCP panel size Number of mid-level providers in the market Percentage of mid-level providers connected to your organization 4 Crimson Market Advantage

7 Three rules for measuring Physician Share Measure both inpatient and outpatient leakage to surface maximum opportunity Identify PCP-specialist connections to rationalize PCP networks Identify PCP splitters to target upstream outreach opportunities Three Rules for Measuring Physician Market Share 5

8 RULE 1 Measure both inpatient and outpatient leakage to surface maximum opportunity The first step in measuring physician share is gaining an understanding of physician behavior to better classify them as loyalists, dissenters, or splitters. However, some planning departments fail to generate a full picture of physician behavior because they limit their analyses to only inpatient volume and revenue. A recent Crimson Market Advantage analysis revealed that, when hospitals analyze physician behavior to include both inpatient and outpatient business, they may identify on average three times as many physicians that split referrals with their competitors. This translates to an additional $52 million in revenue leakage prevention opportunity. 6 Crimson Market Advantage

9 Average Number of Physicians by Splitter Type 3 times as many splitters Loyalists Classic Splitters Dissenters Inpatient Only Inpatient and Outpatient Loyalist 100% to 80% revenue share Classic Splitter 80% to 20% revenue share Dissenter 20% to 0.1% revenue share Your Hospital Total Physician Revenue Your Competitors Three Rules for Measuring Physician Market Share 7

10 RULE 2 Identify PCP-specialist connections to rationalize PCP networks To create more integrated physician networks, hospitals must move upstream in the referral pathway to influence the loyalty of PCPs. As a first step, organizations should measure the number of specialists with whom PCPs share patients. A recent Crimson Market Advantage meta-analysis found that the average PCP shares patients with 68 specialists, reflecting the complexity of PCP networks today. However, the large number of connections also presents a market share opportunity should you be able to improve the connection strength of PCPs to your employed and affiliated specialists. Demonstrate the value of your specialist network by helping PCPs improve practice efficiency and management of complex patient panels. Goals Rationalize PCP-specialist networks by shifting PCP loyalty to employed or strongly affiliated specialists Identify service opportunities with specialist practices that create efficiencies for PCPs Develop valuable services that help PCPs manage complex patient panels 8 Crimson Market Advantage

11 Influencing PCP-Specialist Relationships Number of specialists with whom PCPs share meaningful number of patients Number of PCPs with whom specialists share meaningful number of patients Average Number of Specialists PCPS Have Relationship With By Specialty Speciality Physician Count Specialty Physician Count Emergency medicine 16 Pulmonology 4 Cardiovascular 14 Nephrology 3 Orthopedics 8 ENT 3 General surgery 6 Radiology 3 Oncology & hematology 5 Neurosciences 3 Urology 4 Psychiatry 2 Gastroenterology 4 Spine 1 Three Rules for Measuring Physician Market Share 9

12 RULE 3 Identify PCP splitters to target upstream outreach opportunities Although PCPs exhibit loyalty more to individual specialists and groups rather than to specific facilities, analyzing the facility activity of patients in PCP panels can prioritize PCP splitters for improving relations. Conducting outreach to the PCP base can prove daunting given that the average hospital is connected to approximately 5,500 PCPs. However, two analyses can help create a more effective outreach model. First, categorize PCPs by their degree of facility loyalty. This analysis will likely identify several dozen splitter PCPs, a much more manageable number of physicians for targeted outreach. Next, identify the service lines accessed by the patients of these splitting PCPs. Since PCPs typically show strong preferences for specific specialists or groups, by default they may show strong loyalty to one or two of your key service lines. However, PCPs rarely show loyalty to more than two service lines at any facility. You may be able to leverage your positive connections to improve PCPs perceptions of other, underutilized service lines. 10 Crimson Market Advantage

13 Targeting PCP Outreach Efforts PCPs by Degree of Loyalty 1 Average Crimson Market Advantage Member Loyalists 4% Classic Splitters 14% Prioritize PCPs with whom you already have a significant relationship 82% Dissenters Percentage of Loyal PCPs Across Service Lines 44% 21% 7% Use positive connections to promote services PCPs are sending to competitors Any 1 of 3 Any 2 of 3 All 3 Three selected service lines include: Orthopedics Non-surgical oncology Procedural cardiology 1 Analysis includes PCPs that drive major business to hospitals and health systems. Three Rules for Measuring Physician Market Share 11

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