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Kyruus Blog

Transition Management: Where the population health management rubber hits the road

This post was written by George Pace, Kyruus' Director of Client Development

A health system CEO once told me that anyone who tells you she knows what “population health management” means is lying. While I wouldn’t use similarly strong language to make that point, I have had many conversations with health system and health plan leaders about “population health management”, and through those conversations have come to understand that we do not nearly have a uniform definition of what the term even means. The absence of a uniform definition for population health management can be attributed to market variability, i.e. my population is different from yours, and therefore implies a different approach to managing it.

Topics: Physician Referrals Transition Management population health Referral Analytics Physicians Population Health Management referral misdirection Referral Management kyruus Hospitals Affordable Care Act Patient Access

Can’t Get No (Referral) Satisfaction

In the event of a medical illness, we all want to feel that we will get to the “right” doctor – someone expert in diagnosing and treating our specific condition using the best and latest in medical knowledge. Not surprisingly, there is a large and growing body of evidence suggesting that the “right” doctor for a given patient is the one with the appropriate training and clinical experience in that patient’s condition. This is particularly true in specialist care where procedures are more common and conditions more narrowly defined.

Topics: Information Access Physician Referrals Referral Analytics Physicians referral misdirection Referral Management Big Data kyruus Hospitals Patient Access

Leakage: Aid and Comfort to the Enemy?

This is a post by Dr. Tim Crowley, Vice President of Physician Network Services at Kyruus.

 

Imagine you are a King in Medieval times, and your fortress is under siege by an invading force. You have planned for this by building up more provisions of food and water for your people than your opponent could possibly bring to the battle. As the height of the siege, you make a both terrifying and mystifying discovery: Your own people are sending food and water out to your enemy!

This is the situation many hospital CEOs face every day when they review data revealing their own physicians-- for whom they provide enormous "support" (read subsidies to cover losses), and whose very own paycheck depends on the revenues that specific system was expecting their patients to generate-- are referring out of network. This is leakage in its purest form.

So how do you manage this problem?

The first thing you need is data, something most systems possess (in varying degrees of accuracy and "actionability"). It can be gathered and tracked internally, acquired from payers, data vendors and some cases, directly from the states that monitor and sell Physician identified data (see accompanying list).

Once you’ve determined who is leaking, what they are leaking and where they are leaking to, the next task is to determine WHY these physicians are referring cases out of the system. Then, and only then, can the strategy for dealing with this incredibly exasperating problem be formulated and implemented.

Figuring out the “WHY” requires one-on-one, practice-by-practice, or direct meetings with small groups or "Physician Pods,” to ask why physicians are referring out of network.

Warning: This question needs to be posed in the right way so you don’t make the problem worse. Also, the answers to this question may be quite humbling…

Remember, this is not a time to investigate, castigate, regulate or humiliate. It is an opportunity to ENGAGE with your physician staff, to LEARN about your system and find out why they refer patients away from your facilities and specialists.

The answer(s) to the “why” will become immediately (if not painfully) clear. They may include:

1. Ignorance of services that you currently provide and assumed ALL knew about.

2. Ignorance of specialists who are on staff who provide services you assumed ALL knew about.

3. Ignorance of the quality and better outcomes of the services you provide and assumed ALL knew about

The current generation of Primary Care Physicians, who now or at some time in the past made rounds on their inpatients before hospitalists came along, knew SOMETHING about your hospital and your specialists. However, as this generation approaches retirement, replaced by the new generation of PCP's (who never darken your door), this problem will only get worse.

Unless you ACTIVELY PROMOTE, INTRODUCE and EDUCATE your referring physicians about the services and specialists in your market, THEY WILL HAVE NO WAY OF KNOWING WHAT YOU CAN DO FOR THEM AND THEIR PATIENTS. (IF IT SOUNDS LIKE I AM SCREAMING, IT IS BECAUSE I AM!)

Topics: Referral Analytics Physician Network Strategy

What’s Your Gorilla?

This is a post by Dr. Tim Crowley, Vice President of Physician Network Services at Kyruus.

 

How important is perception? Prioritization? Taking a step back? Incredibly.

 

I recently attended a conference where the moderator presented a famous video of a group of people passing basketballs to each other. The group was asked to count the number of times the basketballs were passed back and forth. In the middle of the exercise, a person in a gorilla suit walks through the room in the video. Afterwards, when the group was asked about the number of passes, one person raised their hand and asked, “What about the gorilla?”

Over two thirds of the group asked, “What gorilla?” Some insisted there was no gorilla at all, and even accused the moderator of showing two videos!

The point, of course, is that if you are too focused on one thing, you could be missing the real threat to your organization. That’s your gorilla.

Personally, I have seen at least three classic examples of this in Healthcare over the last five years:

1. Large Academic Medical Center in the Northeast proudly announces opening of $400 million, state of the art Cardiovascular tower. Meanwhile, 1,000-provider physician group responsible for 17% of their discharges announces change of affiliation to competitor across the street.

2. Large National For Profit Hospital Management Company gathers its senior management to review 700 hours of physician interviews about “how they are regarded by their employed physicians.” Consulting firm opens the conference with the following statement to the eager crowd: “Let me give you the Executive Summary. Your physicians hate you and they think you suck.” If I hadn’t been in the room to hear it myself, I’m not sure I would have believed it.

3. Faith Based System in the Northeast turns around $50 million operating loss into $30 million operating gain in one year. Market crashes and old Defined Benefit Retirement Plan’s unfunded liability triples. Game over. Private Equity Firm buys system.

So, while you, the hospital administrator, are totally consumed by the installation of your new EMR, or your brilliant new E.D or your aggressive new quality improvement and cost containment projects, you might want to look around and see if there any gorillas are in the room.

Here are two “gorillas” that can pose an existential threat to your organization:

1. Lack of a dynamic, effective ONGOING Physician Network Development program. Our proprietary physician tracking data shows that over 1% of physicians move EVERY MONTH. 12-15% change location, leave their practice or move to a different system every year. In addition, a whole generation of Primary Care Physicians is approaching retirement in the next 5-10 years. Without the information to identify those likely to leave and a comprehensive succession plan to help recruit new physicians to care for those patients, you could lose significant market share. If you are not actively engaged with your physicians to build your physician network, you are probably already losing more than you are gaining.

2. Patient outmigration, or "leakage". There is nothing more exasperating to the senior management teams at healthcare organizations than to see huge numbers of referrals go out to other organizations by their own physicians. What’s the point of creating and supporting a physician network if they aren’t willing to support your organizations and keep the care of their patients at the hospitals where they practice? Understanding why they are referring out is critical to fixing the problem.

Kyruus Physician Network Services can help your organization with both of these challenges. We have the tools and services to help you build, train and operate an effective Physician Network Development program and a Referral Management System that will help you promote patient retention.

Topics: Referral Analytics Physicians Physician Network Strategy Hospitals