Quantifying the Value and Impact of Physician Relations Programs: An ROI Model from Emory Healthcare

Transcription

1 Quantifying the Value and Impact of Physician Relations Programs: An ROI Model from Emory Healthcare Lori McLelland - Corporate Director, Market Development (lori.mclelland@emoryhealthcare.org) Cary Overmeyer Senior Market Research Manager (cary.overmeyer@emoryhealthcare.org) The opinions expressed are those of the presenter and do not necessarily state or reflect the views of SHSMD or the AHA Society for Healthcare Strategy & Market Development

2 Learning Objectives 1. Understand how to leverage third party resources to maximize visibility into physician referral patterns. 2. Track changes in physician referral patterns against liaison activities. 3. Calculate the ROI for building out a physician liaison team to achieve your financial targets.

3 Specialty Programs Winship Cancer Institute Brain Health Center Atlanta Hawks Training Facility About Emory Healthcare The only academic health system in Atlanta and the most comprehensive in the state of Georgia $2.8 billion in net revenue $67.4 million in charity care 16,013 staff employees Clinically Integrated Over 2,000 Emory Employed and Private Practice physicians. Over 200 locations across the state. Over 70 Specialties. Over 275 Primary Care Providers Recognized Nationally and is top ranked in Georgia and Atlanta including the two top hospital in the city and state 6 Metro Atlanta Hospitals 1,958 hospital beds 69,093 hospital admissions

4 FY16 Situation 36 Requested Marketing/Sales Initiatives 69,264 Liaison Work Hours Equivalent of 48 FTE s

5 Course of Action Prioritize Initiatives Identification of Real Sales Targets for Calculation of Workforce Resources Methodology for Proving the Resources Demonstrated an Impact

6 Using Claims Based Physician Referral Data Using claims based referral data to understand sales targets and workforce resources. Emory Healthcare sources it market referral data from IMS Physician Insights 360. IMS uses explicit and implicit referrals. Explicit referrals are captured based on what is reported on a claim. Explicit referrals are missing in the majority of commercial claims. Implicit referral relationships based on claim patterns and provider specialty. To capture implicit referrals, IMS requires the following: Patients are shared between two providers within a 12 month period. Providers that share patients have a specialty combination that is clinically logical Qualified provider-provider relationships are reported if they have 5+ patients.

7 IMS Example

8 Data analysis to Identify Physician Targets Identifying physicians to target Analytics Process Claims data provided at the physician to physician level. Proper aggregation of data at the In- and Specialty level. IMS provided Emory Healthcare with raw shared patients data to properly aggregate. Using SPSS and Access we are able to calculate the final % In- for each physician to each specialty.

9 Physician Referral Data % In- Subspecialty Total Subspecialty % In- Subspecialty Surgery - Total Surgery - % In- Surgery - Referring Physician Status Specialty Total Bailey, Lily Competitor 1 Aligned % % % Wilkins, Sonia Competitor 2 Aligned 0 0 0% % % Reid, Christopher Non-Aligned % % % Rampling, Olivia Non-Aligned Endocrinology % % % Hemmings, Carol Non-Aligned Family Medicine % % % Avery, Richard Competitor 2 Aligned Family Medicine % % % Burgess, Donna Non-Aligned Family Medicine % % % Black, Deirdre Competitor 3 Employed Family Medicine % % % King, Stewart Non-Aligned Family Medicine % % % Reid, Ryan Non-Aligned Family Medicine % % % Poole, Sophie Competitor 2 Aligned Family Medicine % % % Bower, Felicity Non-Aligned Family Medicine % % % Scott, Katherine Competitor 3 Employed Family Medicine % % % Walsh, James Competitor 3 Aligned Internal Medicine % % % Walker, Yvonne Competitor 3 Aligned Internal Medicine % % % Underwood, AnneNon-Aligned Internal Medicine % % % Alsop, Alan Competitor 3 Aligned Internal Medicine % % % Nolan, Melanie Non-Aligned Internal Medicine % % % Underwood, Joe Competitor 4 Employed Internal Medicine % % % Kelly, Fiona Non-Aligned Internal Medicine % % % Ferguson, John Non-Aligned Internal Medicine % % % Peake, Kylie Competitor 2 Aligned Internal Medicine % % % Kerr, Nicola Competitor 2 Employed OB/GYN % % % Hughes, Jake Competitor 2 Aligned OB/GYN % % %

10 Physician Targeting Dilemma Which physician should be targeted? Physician s with growth opportunity Assumed physicians who share between 30% - 70% of their patients with our network presented the greatest opportunity. Physicians without growth opportunity Physicians who share over 70% are currently loyal Once a physician shares 70% of their referrals, much of the remaining growth potential is limited due to structural barriers in the market.» Patient preference» Clinic locations» Current relationships or alignment Physicians with under 30% are disloyal and are less likely to change their patient sharing pattern.» Disloyalty is also caused by structural barriers within the market and our perceived reputation. Clinic locations System alignment Past service/ Reputation Current relationships

11 Final Physician Targets Referring Physician Status Specialty Total % In- Subspecialty Total Subspecialty % In- Subspecialty Surgery - Total Surgery - % In- Surgery - Bailey, Lily Competitor 1 Aligned % % % Wilkins, Sonia Competitor 2 Aligned 0 0 0% % % Reid, Christopher Non-Aligned % % % Rampling, Olivia Non-Aligned Endocrinology % % % Hemmings, Carol Non-Aligned Family Medicine % % % Avery, Richard Competitor 2 Aligned Family Medicine % % % Burgess, Donna Non-Aligned Family Medicine % % % Black, Deirdre Competitor 3 Employed Family Medicine % % % King, Stewart Non-Aligned Family Medicine % % % Reid, Ryan Non-Aligned Family Medicine % % % Poole, Sophie Competitor 2 Aligned Family Medicine % % % Bower, Felicity Non-Aligned Family Medicine % % % Scott, Katherine Competitor 3 Employed Family Medicine % % % Walsh, James Competitor 3 Aligned Internal Medicine % % % Walker, Yvonne Competitor 3 Aligned Internal Medicine % % % Underwood, AnneNon-Aligned Internal Medicine % % % Alsop, Alan Competitor 3 Aligned Internal Medicine % % % Nolan, Melanie Non-Aligned Internal Medicine % % % Underwood, Joe Competitor 4 Employed Internal Medicine % % % Kelly, Fiona Non-Aligned Internal Medicine % % % Ferguson, John Non-Aligned Internal Medicine % % % Peake, Kylie Competitor 2 Aligned Internal Medicine % % % Kerr, Nicola Competitor 2 Employed OB/GYN % % % Hughes, Jake Competitor 2 Aligned OB/GYN % % %

12 Market Focus Primary Care & Emory Healthcare opportunity focused on 338 private PCP s, Employed PCP s and non-hospital based Specialists. recruitment focused on 35 unaligned PCP s Brain Health & Neuroscience Referral Splitters 106 PCP s, 14 Neurologists Cardiovascular Health Market Development efforts focused on 329 non- referral splitters & 20 non-atlanta hospitals Referral Splitters 176 PCP s, 23 Endocrinologists, 93 Cardiologists, 37 OB/GYN s 20 Non-Atlanta hospitals for ECMO focus Hospital Medicine and Critical Care Medicine Organ Failure & Transplantation Referral Splitters 113 Gastroenterologists, 26 Nephrologists, 42 Pulmonologists Musculoskeletal Market Development efforts focused on introducing new TEC orthopaedic physicians in EJCH area

13 Sales Funnel Differentiator(s) Determine patient/physician need and opportunity Clinical Trials Reputation The typical physician must have an average of 7 targeted discussions on the same topic (impressions) before a taking action on a referral pattern change (engagement)* *Source: Barlow & McCarthy Quality Access Trust Relationship REFERRAL The delivery of disparate messages to the same audience creates an increased number of unique exposures, thereby decreasing the likelihood that any impression occurs. Calculated Hours = xx FTE s Available Hours = xx FTE s Calculated by (number of meetings * number of eligible targets)/ visits per week

14 Workforce Calculation Focus Target(s) # of Physician Targets # of Visits FTE calculation Transplant Liver Kidney Lung Non- Gastroenterologists/Hepatologists Nephrologists Pulmonologists

15 Goal Setting Sensitivity Analysis 7% Increase % of # Change Net % Change 6% Increase % of # Change Net % Change 4% Increase % of # of Total Emory Medicine Signature Programs Brain Health 42% % 438 3% % 375 3% % 250 2% % of # Change Net % Change Heart & Vascular 50% % % % % % % Transplant 43% % 75 3% % 64 3% % 43 2% PCP 67% % % % % % % Specialists 71% % % % % % %

16 Outreach Goals CM per Patient 1 % In- Referral Increased # of Patients Increased % Increase in Referral Volume Total Increased CM Liaison hours per program Liaison Cost Program ROI Ratio Emory Medicine Signature Programs 1,345 $2,010,249 12,500 $562,500 $3,062, Brain Health & Neurosciences (excludes Psychiatry) $1,000 2% 250 4% $250,000 2,500 $112,500 $137, Heart and Vascular $1,000 2% % $1,000,000 5,000 $225,000 $775, ECMO $100, $2,000,000 2,500 $112,500 $1,887, Organ Transplant (Transplant Surgeries Only) $5,000 3% 75 7% $375,000 2,500 $112,500 $262, $8,000, $337,500 $7,662, Recruitment 3 $200,000 <per PCP> 10 $2,000,000 Growth Opportunity 2 $1000 6,000 $6,000,000 PCP 2 $1000 4% 3,000 6% $3,000,000 Specialty 2 $1000 4% 3,000 6% $3,000,000 $ Total 14,575,000 17,500 $900,000 $10,725, CM per Patient equals EHC Contribution Margin Target divided by Unique Patient Targets. 2 Estimated by using the lowest of signature programs CM per patient. 3 Recruitment CM equals TEC/ESA hospital downstream value divided by current % of in-network referrals.

17 Liaison Visits - Private Practice # Visits to Target MD s Quality Forum Liaison Vacancy # of Targeted Physicians % Eligible In- from Targets Target % of In- Outreach QTR QTR QTR Targets Private Practice PCP % 15% 16% 17% 17% Private Practice Specialists % 21% 22% 22% 22% Private Practice PCP Private Practice Specialists Prospective Members

18 Outreach Liaison Goal Tracking % of In- August July 2015 (Baseline) November October 2015 (Qtr 1) # of In- Total # of Market # of Physician Targets Goal % of In- # of In- Total # of Market # of Physician Targets Change in % In- Referral Goal Status % of In- February January 2016 (Qtr 2) # of In- Total # of Market # of Physician Targets Change in % In- Referral Goal Status % of In- # of In- May April 2016 (Qtr 3) Total # of Market # of Physician Targets Change in % In- Referral Goal Status Private Practice and ESA ESA* 15% % % 17% % 17% % Private PCP 13% % 16% % 17% % 18% % 20% % 22% % 22% % 23% % Private non-hospital Specialists 50% % 53% % 55% % 53% % Subspecialty 50% % 47% % 48% % 49% % Surgery - (includes CTS, Thoracic and Vascular Surgery) Heart &Vascular 37% % 33% % 35% % 35% % Brain Health Neurology 50% % 51% % 48% % 51% % Surgery - Neurology 50% % 53% % 54% % 52% % Transplant Transplant 33% % 34% % 36% % 36% % Renal* 30% % % 33% % 32% % Liver* 50% % % 54% % 54% %

19 Deeper Dive There are two possible outcomes: If the result confirms the hypothesis, then you've made a measurement. If the result is contrary to the hypothesis, then you've made a discovery. - Enrico Fermi

20 Heart & Vascular Market Dynamics Non- Baseline QTR 1 QTR 2 QTR 3 QTR 4 # of Targets (Including Lost Physicians) # of Baseline Referring Physician Targets % of Eligible among Baseline Only 43% 42% 43% 43% % of Eligible for QTR 42% 40% 40% Changes from Baseline # of Physicians who increased to % from 30-70% # of Physcians who decreased from % into 30-70% # of Physcians who decreased to under 30% from 30-70% # of New Physicians in 30-70% (from baseline) # of 30-70% Physicians dropped from data (baseline) PCP Baseline QTR 1 QTR 2 QTR 3 QTR 4 % of Eligible from all PCP 40% 42% 47% 49% % of Eligible from TEC PCP 82% 83% 87% 87% % of Eligible from ESA/EMG 27% 29% 27% 30% % of Eligible from Private Practice PCP 26% 27% 32% 33%

21 Outcomes CM per Patient 1 % In- Referral Increased # of Patients Increased % Increase in Referral Volume Total Increased CM Liaison hours per program Liaison Cost Program ROI Ratio Emory Medicine Signature Programs 662 $3,200,000 12,500 $562,500 $2,637, Brain Health & Neurosciences (excludes Psychiatry) $1,000 <1% 50 <1% $50,000 2,500 $112,500 ($62,500) 0.4 Heart and Vascular $1,000 1% 500 2% $500,000 5,000 $225,000 $275, ECMO $100, $2,200,000 2,500 $112,500 $2,087, Organ Transplant (Transplant Surgeries Only) $2,500 4% 90 8% $450,000 2,500 $112,500 $337, $8,900, $337,500 $8,562, Recruitment 3 $200,000 <per PCP> 12 $2,400,000 Growth Opportunity 2 $1000 6,500 $6,500,000 PCP 2 $1000 3% 2,500 5% $2,500,000 Specialty 2 $1000 6% 4,000 8% $4,000,000 1 CM per Patient equals EHC Contribution Margin Target divided by Unique Patient Targets. 2 Estimated by using the lowest of signature programs CM per patient. 3 Recruitment CM equals TEC/ESA hospital downstream value divided by current % of in-network referrals. Total $12,100,000 20,000 $900,000 $11,200,

22 Three Key Take-Aways Claims based data provides market insight into your physician behavior. A dedicated analytics resource allows deeper synthesis of the data in order to react to market changes. The ability to monitor trends in the market is key to proactively reach your ROI goals.

23 Questions? Lori McLelland - Corporate Director, Market Development (lori.mclelland@emoryhealthcare.org) Cary Overmeyer Senior Market Research Manager (cary.overmeyer@emoryhealthcare.org) The opinions expressed are those of the presenter and do not necessarily state or reflect the views of SHSMD or the AHA Society for Healthcare Strategy & Market Development