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How You Can Get a Competitive Edge Using Claims Data Intelligence

Claims Data Intelligence
The Voice of the Healthcare Business

How You Can Get a Competitive Edge Using Claims Data Intelligence

Revenue is critical for all businesses, but hospitals and health systems have been hit hard with inflation and labor shortages. And before that – COVID. Health leaders are tasked with strategically uncovering new revenue opportunities and assessing the potential returns on investment. To make confident business decisions, data is necessary. In your analyses, using claims healthcare data analytics that includes both what’s happening inside and outside your facilities provide market insights that you wouldn’t have otherwise. Would you like to know who’s getting the most referrals? Or maybe who is getting the most of a specific procedure?

With the right data, you can keep on top of the market and it’s revenue potential.

Prepare for Contract Negotiations With Claims Data

Using data, you can check if other health systems are negotiating better reimbursements by payers for specific procedures. How does the care setting affect those reimbursement? If there is any money being left on the table, you can be prepared with the numbers for contract negotiations. With claims data you can answer these questions:

  • What are my competitors contract rates?
  • Are we getting under paid?

Manage Referrals, Don’t Let Them Manage You.

Referrals are your bread and butter. Relationships are a big part of a successful referral program. But if you want to know how you’re doing, you need to know who is referring and who isn’t. Of course you want all the out-of-network referrals that you can get, but you have to count on in-network referrals. You can use claims data to keep an eye on internal referrals. If you find a gap, it helps you know who to talk to find out why. Maybe patients are requesting a certain facility and need an out-of-network provider.

With healthcare claims data analytics you can get insights into referral patterns. This allows you to focus your marketing efforts to a targeted group of physicians. You can identify high-referring physicians. Also, you can determine who in a practice is or isn’t referring – to get refined in targeting conversations. Claims data can help you answer these questions:

  • Which practices aren’t referring to us?
  • Of the practices that do refer to us, which practitioners are not?
  • Where are the potential areas of opportunity based on procedure counts and patient volume?

Use Claims Data to Strategically Expand.

Use market data to look at the competitive landscape and to determine where market opportunities are. The right market data allows you to analyze the presence of an entity that you might want to acquire, determine whether you should enter a new market or expand market share by offering a new service.

If you’re considering opening a new outpatient cardiology center, you can determine the number of procedures by care setting by using the appropriate service or sub service line. You can determine if there is enough need to justify the new facility. You can also use claims data to look for pockets of need which may only need some additional marketing. Claims data can answer these questions:

  • Should we acquire this entity?
  • Should we build a new cardiology facility?
  • Are there hidden pockets of need we can fill?

For everyone’s sake, Hospitals and health systems must adapt in tough times. Claims data can give you insights to help you make informed strategic decisions and discover new avenues for revenue.

Read this case study to learn how Lehigh Valley Health Network used claims intelligence to support growth initiatives after an acquisition.

The DNA of Healthcare

At LexisNexis Risk Solutions, our goal is to provide the healthcare industry with insights and innovations to improve outcomes, grow market share, reduce fraud and increase compliance.

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