Luke Wylie

Data Scientist

Many Americans want access to quality care close to where they live. However, many healthcare providers in rural and exurban America are struggling to keep their doors open. They're wrestling with a rural care network revenue problem. Declining patient volumes, decreased reimbursements, and a looming transition of their business model from fee-for-service to value-based care is not generating enough revenue to cover the costs. Adding to the list, these systems also have to overcome the perception that local care is objectively worse than what is offered in urban centers*.

To reverse this declining trend, we believe that these health systems can engage their local community and build a care network that provides high-quality care to local patients and help slow the flow of patients to urban centers. To illustrate this idea, we’ll use our TEAM™ platform to investigate an exurban market and provide insights about what this local system can do to strengthen their local network and keep patients in their network.

Primary care providers are rightfully the quarterbacks of care for their patients and should be the starting point in any system-wide analysis for a facility. A thorough understanding of a facility’s primary care market can provide tremendous downstream revenue if taken advantage of by a facilities’ physician liaisons.

TEAM provides this information at a glance using an asset-based visualization we call the market map where physician boxes are sized by the total volume of patients they see and are colored based on hospital preference.

We classify the physicians based on their patient volumes that end up at our selected facility. For instance, we classify Loyalists as physicians who keep more than 75% of their patients in our facility. These are typically our hospital-based or employed physicians, and we want to keep them on in our network. However, the more significant opportunity to drive patient volume to our facility lies in Splitters which have between 25% and 75% of their patients that end up in acute care and are being seen at our facility.

These are the physicians that we want to have a conversation with around quality, cost, access, and branding at our facility to drive downstream volume.

Note: Physician names have been redacted for privacy.

Figure 2. Internal Medicine (Non-Specialist) “Splitters” to our hospital- TEAM

Here we see two physicians that should be potential targets to increase downstream patient volume to our hospital. Both of these physicians have high patient volumes, are practicing in the same city as the hospital, and while a good portion of their hospital-bound patients end up at our facility, a majority end up at other facilities.

For the sake of brevity, we will focus here on the top physician:

Note: Physician and network names have been redacted for privacy.

Figure 4. Our physician’s hospital relationships – TEAM. The grey lines are sized by patient volumes.

This physician has two main hospitals where his patients end up:

  • Hospital 1 - Our hospital.
  • Hospital 2 - A rural hospital to the northeast of our facility.
  • There are also tertiary hospitals, mainly based in the city and its suburbs, that also treat the physician's patients.

From a growth perspective, it’s necessary to understand the reasons behind these relationships. Perhaps our physician splits his time between office locations at Hospital 1 and Hospital 2 or many of his patients are located closer to Hospital 2 which would explain the trend seen above. Also, it is important to discuss the urban hospitals where our physician's patients are receiving care and the reasons why.

For example:

  • Are there access issues around certain service lines at our facility which are driving patients elsewhere?
  • Is there a perception issue around the quality of services patients are receiving in urban facilities that are also offered at our facility?
  • Are patient health plans directing them to physicians at other facilities?

* Rieber GM, Benzie D, McMahon S. Why patients bypass rural health care centers. Minn Med. 1996;76(46-50).

December 11, 2016

The Rural Care Network Revenue Problem