Identifying Leakage Opportunities to Grow Volume · Identifying Leakage Opportunities to Grow...

Identifying Leakage Opportunities to Grow Volume Tricia Anderson, Business Development Director, Texas Health Resources Susan Boydell, Partner, Barlow/McCarthy

Marketing and Physician Strategies Summit April 2014

Agenda

§  Defining leakage §  Where’s the leak? §  Plugging the hole or holes §  Texas Health case studies §  Results §  Q&A

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ü Where to look for leakage ü  How to use the data you have and what do when you don’t

ü  Repor8ng to get a9en8on

How big is the problem

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only

35% to 45%

of patient referrals ever reach the

referred-to-clinic or hospital

Treatment options are expanding

4

Growth of specialties are growing rapidly between 1970 and today and when primary care doctors are

overwhelmed with patient care, the time they have to learn about new sub-specialties is extremely limited.

11 1970

160 present

Cost of referral leakage

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Every

1% of “KEEPAGE”

$1,000,000 in additional revenue for a health system

Data from Mission Point Health Systems

How to improve referral leakage

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Educate Quantify and track Identify opportunities

A PCP Refers to a Specialist…

Confidential And Proprietary – All Rights Reserved Texas Health Resources

•  656 referrals per year •  55 per month •  3 per day

PCP Referral Patterns

Specialty Average Annual Referrals Average Monthly Referrals

GI 107 9

Orthopedics 69 6

Cardiology 51 4

Urology 36 3

General Surgery 34 3

Neurology 34 3

Pain Management 29 2

OB/GYN 14 1

Neurosurgery 11 1

Oncology 10 1

Vascular Surgery 9 1

Other 252 21

TOTAL 656 55


Referral Grid Example Secondary Referrals

Referring Physician/ Specialty

Physician Sub-‐Specialty

Physician Sub-‐Specialty

Dr. A Pain Management

Dr. B Neurologist

Dr. C Neurosurgeon

Dr. D GI

Dr. E Colon Rectal

Dr. F Oncologist

Dr. G General Cardiology

Dr. H EP

Dr. I Vascular Surgeon

9 Confidential And Proprietary – All Rights Reserved Texas Health Resources

10

Understanding the Referral Funnel

Secondary referrals are key in controlling leakage

Colon Rectal Surgeon

PCP GI

Oncologist Where is it leaking?

The downstream opportunity

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37 referrals from primary care to orthopedics

74 office visits (initial and subsequent)

59 in-office diagnostics

21 office procedures

9.9 outpatient procedures/surgeries

3.3 inpatient procedures/surgeries

12 referrals out for diagnostics

7 referrals to other specialists (e.g., physical therapy, pain management)

Texas Health Resources Overview

§  Largest hospital system in North Texas §  Non-‐profit, faith-‐based §  Formed in 1997 §  24 acute-‐care and short-‐stay hospitals owned, operated, joint-‐ventured or

affiliated −  16 acute-‐care hospitals −  6 short-‐stay hospitals −  1 transi8onal care hospital −  1 rehabilita8on hospital

§  4,100 licensed beds

§  20,500 employees

§  5,500 physicians with ac`ve privileges

§  750 employed physicians


THR Hospitals (wholly-owned)

1.  Texas Health Harris Methodist Fort Worth 2.  Texas Health Arlington Memorial 3.  Texas Health Presbyterian Dallas 4.  Texas Health Harris Methodist Hurst-Euless-Bedford 5.  Texas Health Harris Methodist Stephenville 6.  Texas Health Harris Methodist Azle 7.  Texas Health Harris Methodist Southwest

8.  Texas Health Harris Methodist Cleburne 9.  Texas Health Presbyterian Plano 10.  Texas Health Presbyterian Allen 11.  Texas Health Presbyterian Kaufman 12.  Texas Health Alliance 13.  Texas Health Presbyterian Denton

Plano

Allen Denton

Kaufman

Azle

Cleburne Stephenville

Southwest Fort Worth

Arlington

HEB

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Alliance

12

A little history…

¨  2008 - THR suffers its first loss

Ø  Volumes decline, competition increases Ø  Referral development gets attention

Ø  Existing structure assessment

¨  2009 - Business Growth Strategy team formed

Ø  Existing Physician Liaisons assigned to hospital Ø  1 Director, 10 Growth Specialists, 1 Team Leader (added 2010), 1 Analyst, 1 Administrative Assistant

¨  2012 THR reorganized into 3 zones

Ø  Current structure reassessed

¨  2013 Business Growth Strategy restructured

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Business Growth Strategy – The Evolution

2008 – Existing structure assessment THR had “pieces” of a physician liaison program

¨  Liaisons understood rela8onship building ¨  No selling ¨  Reten8on vs. growth ¨  Short on strategy and focus ¨  No measurement or tracking ¨  No coordina8on or consistent approach ¨  Opera8onal accountability very spo9y


Business Growth Strategy – The Evolution

2010 – 70% turnover

¨  8 new Growth Specialists were hired ¨  Increased focus on results ¨  Sales training provided by Team Leader/Manager ¨  Adjustment to incen8ve plan

2012 – THR reorganized into 3 geographical zones

¨  Triad leadership structure ¨  Business Growth func8on re-‐evaluated ¨  Exis8ng BG team – varying levels of effec8veness / skill set

2013 – Business Growth restructure


From “Entity” Thinking to “Zone” Thinking and Beyond

•  Entity Thinking:

Ø  What needs to happen to protect and grow Dr. X’s volume at my hospital? Ø  What is SHE doing talking to MY doctor?

•  Zone Thinking:

Ø  What needs to happen to protect and grow orthopedic volume in my zone? Ø  What can WE offer OUR physician to expand his referral base in OUR zone?

•  System Thinking:

Ø  What needs to happen to protect and grow scoliosis volume for THR? Ø  What can WE offer OUR physicians to further align them with THR?


Sales Philosophy

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Where we started… Where we moved…

Rela`onship Building

Needs-‐based Selling

What we expect… Ac8onable Intelligence Quan8fiable Results

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Achieving Quantifiable Results

Business Growth Tool Kit

Physician Growth Strategies

Ease of Use Removing Barriers

Referral Development Connec8ng the right physicians

Physician Growth Strategies

Specialist

Possible referral streams

Potenàl new referral relaònships

Introducòn to potenàl referring physicians

Introducòn Strategy


Growing targeted physicians

Discover referral needs of PCP

Poten8al new referral rela8onships – mee8ng

PCP’s needs

Physician introduc8ons

Follow Up

Needs Based Strategy


“Discovery” Goals

•  Be perceived as a resource – not a sales person •  Ask open-ended questions to engage staff and physician in meaningful

conversation •  Identify decision maker(s) •  Understand practice patterns and needs •  Become a resource by timely follow up •  Identify opportunity to align PCP with THR and THR aligned specialists


“Un-Tapped” PCP’s

•  What has been your experience with THR (hospital specific)? •  What is your greatest referral need? •  What challenges do you face in referring patients with specific needs/requests?

−  Insurance Plans (Medicare, Medicaid, etc.) −  Bilingual −  Appointment availability −  Location

•  Do you find that some of your patients delay seeing a specialist/seeking treatment/having surgery due to financial concerns?

•  What healthcare concerns/disease/conditions do you feel your patients could

benefit from additional education?


Understanding the Needs of the Physician Specialist

§  Describe the referral process to your prac8ce. §  What are the barriers in referring to you? (availability, phone tree, insurance, office staff issues) §  Are there opportuni8es to improve the referral process? §  What differen8ates you from your compe8tor? What are your key messages? §  What insurance plans do you accept? Do not accept?

§  What types of pa8ents/cases do you most desire? §  Who are your current referral sources? How were those acquired? §  Desired referral sources? §  Are you willing to offer priority appointments to specific referral sources? (Example: first

appointment of the day or aber lunch)

§  How do you track referrals? §  Do you have a pa8ent success story you are willing to share? §  What outreach ac8vi8es are you interested in? (Advances in Medicine, physician to physician

visits, CME presenta8ons, PR spokesperson) §  What is your capacity goal?

§  What can I do to make you more successful?


Referral Grid Example Initial Referrals

PCP Ortho Neuro GI CV

Dr. A

Dr. B

Dr. C

Dr. D

Dr. E

Dr. F

Dr. G

Dr. H


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Business Growth Methodology

Putting The Tools To Use

•  Minimum 2013 surgical volume: 24 •  Minimum Average CM: $1000

•  Target Specialty: Neurosurgery, Orthopedics, General, GYN, CV High / Moderate CM

•  Determine Growth Strategy: Referral Development / Ease of Use

•  Loyal physicians with high or moderate CM, at or near capacity, with minimal growth poten8al (Grow 1 more)

•  Splieers with high or moderate CM splijng between THR and investment facili8es

Business Growth Plan Methodology

Research Physicians

Iden`fy Growth Physicians

Determine Reten`on Physicians

Iden`fy Discovery Physicians

•  Physicians u8lizing THR but limited knowledge of growth poten8al. Requires further inves8ga8on


Call Plan Requirements

•  140 physician growth calls per month •  Growth calls defined: A conversa8on with

a target physician or key office staff member (decision maker). Each call must have a documented objec8ve, outcome and next step.

•  20 calls per month may be dedicated to “non-‐target growth” ini8a8ves. Examples: scheduling mee8ngs, non-‐target service line calls, delivering hospital material, internal mee8ngs, etc.

•  All calls documented into Salesforce.com by end of day each Friday.

•  70 physician growth calls per month •  Growth calls defined: A conversa8on with

a target physician or key office staff member (decision maker). Each call must have a documented objec8ve, outcome and next step.

•  All calls documented into Salesforce.com by end of day each Friday.

•  Responsible for a9ending hospital and zone leadership mee8ngs. Present growth results, ease of use issues iden8fied, field intelligence, etc.

•  Manage BGS in their zone. Holding team accountable to following their business plan, complete documenta8on, results achieved, etc.

30 Confidential And Proprietary – All Rights Reserved – Texas Health Resources

Business Growth Specialist Business Growth Manager

Case Studies Getting to Specifics

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Leakage: Orthopedic Referrals From Employed PCPs

•  THR aligned orthopedic surgeons did not accepted new “insurance plan” pa8ents.

Problem

•  THR employed PCP’s have large “insurance plan” pa8ent popula8on Opportunity

•  PCP’s were forced to refer pa8ents to surgeons aligned with compe8tors LEAKAGE


Presenting the barrier to hospital leadership

Average “Insurance” population per PCP

118

Average PCP visits per member 8.5 per year

Average specialist visits 4.5 per year

THR Entity “Insurance” population 5,310

THR Entity PCP visits 45,135/yr 3,761/mo 179/day

THR Entity specialist visits 23,895 /yr 1,991/mo 95/day


Selling the Opportunity

Specialty Hospital’s PSA

Employed PCP’s

Average Annual

Referrals per PCP

Hospital’s Orthopedic

Referral Opportunity

Average Annual Cases

(30% Conversion)

Orthopedics 45 69 3,105 932


Presenting the Results

35 Confidential And Proprietary – All Rights Reserved – Texas Health Resources

New Surgeons 2012 Volume 2013 Volume 2012 CM 2013 CM

6 99 757 $601,778 $5,275,733

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Leakage: Understanding the Mammography Funnel

Screening Mammograms Ex. 12,000

Diagnostic Mammograms Ex. 3,000

25%

Biopsies Ex. 600

5%

Surgeries Ex. 210 1.75%

National Average THR Entity 2013

Screening Mammograms 5,301

Diagnostic Mammograms 1,540 29%

Biopsies 79

1.5%

Surgeries 25

.47%

186 additional

biopsies need to meet national

average ~$4,000 CM/

case 186 x 4,000 $744,000

68 additional surgeries need to

meet national average

~$7,000 CM/case 68 x 7,000 $476,000


Presenting a Solution

•  Create a Worry Free Zone for patients

•  Nurse navigator to call patients requiring further tests / surgery

•  Offer next day appointment with breast center surgeon

37 Confidential And Proprietary – All Rights Reserved –Texas Health Resources

ER Leakage

•  Patients who were treated and discharged from the ER with instructions to follow up with an orthopedic surgeon

•  Name of on-call physicians was presented is requested.

•  Exclusive call group agreed to offer same or next day appointments

•  Quarter 1, 2013: Pilot to offer follow up appointment scheduling from the ER with the orthopedic call group was offered to patients.

38 Confidential And Proprietary – All Rights Reserved –Texas Health Resources

Results


Employed Cardiology Practice

•  Feedback from referring physicians —  Overall poor customer service —  Long hold times on phone —  Calls often not answered —  New patient appointment - 2 weeks —  Front office staff – not accommodating – not friendly —  PCP’s referring more to competing CV practice —  Competition offers next day appointments

•  Feedback from surgeons requiring cardiac clearance –  Unable to accommodate patient in timely manner –  Employed CV practice agreed to clear patients w/in 10 days but have not

delivered – taking up to 16 days –  One neurosurgeon rescheduled 6 surgeries in 2 month period due to patients

not cleared for surgery in promised time frame –  Competing CV practice clears patients w/in 4 days

•  This employed group of CV physicians performing fewer cases than employed groups in other markets


CV Opportunity

Physician Group Average 2013 Case per physician

CV A – 5 physicians 217

CV B – 5 Physicians 219

CV C – 11 physicians 171

Variance 218 – 171 = 47

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CV C 2013 Vol. CV C Avg. CM per case 2013

CV C Total CM 2013

1,882 $6,396

$16,156,017

Potential Ave. Incremental per physician

Total Incremental Volume

CV C Avg. CM per case 2013

Total incremental revenue

47 47 x 11 = 517 $6,396 $3,306,732


27#

23#16#

4#3#

20#

THR$En'ty$"A"$Accepted$

THC#

USMD#

Other#THR#

Meth.#Mans.#MCA#

Other####

THR “A” Transfer Inbound Volume

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THR “B”

THR “JV”

Comp A”

Comp “B”


Nov. 15, 2013 – March 15, 2014

THR “A” Transfer Declines

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THR “B”

THR “JV”

Comp A” Comp “B”

Other THR

Other


Nov. 15, 2013 – March 15, 2014

Arlington Market Out-migration

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Comp “B”

THR JV

Comp “A”

Comp “C” FS ER

THR C

Other


Nov. 15, 2013 – March 15, 2014

Patient Transfer Opportunity

Transfer Status Volume Received

Average CM Volume Missed

Revenue Status

Accepted by THR “A” 93 $3,710 $345,030 Zone leadership

aware. Working with

THR “A” Triad to improve bed availability issues.

Declined by THR “A” $3,710 174 ($645,540)

Out-‐Migra8on $3,710 44 ($163,240)

TOTAL 93 218 ($463,750)


Taking another look at retention physicians

Grow One More Strategy

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“Top 20” Bubble Graph


“Grow One More” OP Back and Spine Opportunity

•  “Grow One More” Question: Dr. B: What needs to happen to allow you time to do ONE more case a week at our hospital?

•  “Grow One More” Answer: Dr. B pitched the idea of an “outpatient day”, where he flips rooms every Friday. He could do 10-12 surgeries every OP day, if we are willing to accommodate with appropriate nursing/scrub staffing and 2 anesthesiologists. This would free up the rest of his week for more complex surgeries, which are his specialty.

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Potential

Incremental OP Volume (5/week)

Average OP CM per case

Incremental Revenue

260 / year $3,089 $803,140


Business Growth ROI 2013 Reporting - Tool

Zone Target Phy.

Q’s 3&4 2012

Volume

Q’s 3&4 2012 CM

Q’s 3&4 2013

Volume

Q’s 3&4 2013 CM

Volume Variance

CM Variance

Zone A 25 Target Physicians

1,100 $19,415,939 1,332 $26,395,865 232 $6,979,926

Zone B 12 Target Physicians

421 $6,317,952 666 $11,199,318 245 $4,881,366

Zone C 13 Target Physicians

583 $16,308,793 551 $16,978,500 (32) $669,707

TOTAL 50 Target Physicians

2,104 $4,2042,684 2,549 $54,573,683 445 $12,530,999


Questions?

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Tricia Anderson, Business Development Director, Texas Health Resources [email protected] . (682) 236-‐6782

Susan Boydell, Partner, Barlow McCarthy [email protected] . 469-‐547-‐4701

Identifying Leakage Opportunities to Grow Volume · Identifying Leakage Opportunities to Grow...

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