When patients obtain care outside of the primary care delivery system or physician network to which they are attributed, this out-of-network utilization can have tremendous impacts on the financial health of a provider organization — especially when that patient is part of a value-based contract.
Receiving care out of network contributes to the costliness of health care. Here’s why:
- Siloed data. Despite all the hype around interoperability and data, health industry stakeholders are not always able to share their data. That makes it difficult to manage patients who go to clinics or hospitals that are not connected.
- Wasted resources. Costs increase as patients aren’t as carefully managed. The results are often redundant services and/or services delivered by higher cost practitioners — with no increase in quality.
- Disconnected care. Effectiveness of care coordination declines because clinicians can’t easily communicate.
- Poor results. Patient well-being and outcomes may become compromised.
The biggest impact patients going out of network can have is on the continuum of care. An in-network provider cannot manage the quality of care that a patient receives when they leave the system. How is a provider to know what a patient is seeing an outside physician for if a patient does not report the information, and what does that mean for the treatments they’re receiving from in-network doctors?
NYUPN Clinically Integrated Network, a collaboration between the University Physician Network and NYU Langone Medical Center in Manhattan, New York, proactively analyzed its data and identified an issue with patients seeking care outside their care provider network. Within weeks, they applied data to help alleviate the issue.
New York City is home to many world-renowned health care organizations, all within a small geographic area. It’s easy to see how patients seeking care with out-of-network physicians or facilities could become a problem. Group leaders knew they needed to influence patients to stay within NYUPN’s network of clinicians and hospitals, and they determined the way to do so was to influence a critical patient gatekeeper: their physicians.
Using reports that allowed them to drill down to source data, NYUPN population health leaders aggressively educated physicians about how often their patients used out-of-network resources, and discussed the consequences that such usage had on quality of care and managing costs.
Their efforts worked. NYUPN increased its in-network utilization by 5 percent.
To learn more about using data to take action on in-network utilization, download the latest topic spotlight from Optum: “Increasing patient in-network utilization with prescriptive data and analytics.”
About the Author:
Leslie Cozatt currently serves as Campaign Director, OptumIQ. She directs the development of content that spotlights the role of data and analytics in health care.
She brings to her role more than 20 years of experience developing B2B and B2C integrated marketing campaigns for companies including ThreeWire, Eliance and 3M.
Leslie attended the University of Minnesota and graduated from Wellington College with a BS in international business & communication.