Both the formal and informal relationships that exist between healthcare providers, healthcare providers and facilities, and multiple organizations influence the care patients receive in ways that may not immediately be apparent. Understanding these relationships and their impact on treatment decisions has long been a goal of brand teams.

Before the development of patient-level data, the more nuanced and informal relationships were difficult to identify and catalog. But today, patient-level data allows us to monitor patient movements between providers and better understand how each provider is related.

FORMAL RELATIONSHIPS

Formal provider relationships and affiliations, including professional-to-professional, professional-to-organization and organization- to-organization, are fairly straightforward and important to understand, as they can impact which treatments are chosen and where and when procedures take place. These types of relationships can be identified from a number of publicly available sources, such as websites. For example, to market their services to patients, many providers— particularly facilities—have their own websites featuring lists of affiliated physicians.

Group practices and their participating physicians often can be identified by using publicly available information or demographic data from physician organizations. Providers whose practice has the same address and/or same practice name can easily be identified as working together.

In addition to publicly available data, other efforts—most often surveys of providers—are undertaken in order to learn more about provider affiliations. As these affiliations change, surveyors are consistently reaching out to providers to keep their information current.

INFORMAL RELATIONSHIPS

Often, however, the informal relationships that exist between providers, such as when one physician regularly refers patients to one particular specialist or facility, are of most interest to brand teams. Generally, the only way to pinpoint informal relationships is to track patients’ activities—anonymously— over time.

The main healthcare contact and director of care for many patients is their primary care physician—most often a doctor who practices general, family or internal medicine. These physicians provide the first level of care and are also the ones who typically direct patients on where and whom to visit when additional care is needed. A primary care physician may send patients to a lab, imaging facility, hospital or specialist. In some cases, such as when a patient has HMO insurance, the primary care doctor must refer the patient for other services if they are to be covered by the payer.

Along with primary care physicians, providers from many different specialties and facilities also influence the movement of patients between providers.

While the formal aspect of these relationships is important, it’s the informal relationships between providers that can help brand teams evaluate the value of target physicians and determine marketing strategies.

TRACKING PATIENT MOVES

Each time a patient visits a provider or facility, a financial record (at the very least) is created. These records, including medical, lab test and prescription claims, can be studied after the patients’ personal information is removed and replaced with irreversibly encrypted patient keys. By matching claims referencing the same patient key, it’s possible to identify the path a patient took to receive care.

In Figure 1, a patient’s path from the primary care physician to a hospital included stops at pharmacies, labs and a specialist. By studying these paths across millions of patients, it’s easy to see repeating trends, such as patient movement from one primary care doctor to a particular specialist. In this example, brand teams likely would be interested in determining how often Dr. A’s patients visited Dr. B, and if Dr. B was affiliated with and practiced at the identified hospital.

In addition, studies can be done that identify the volume of shared patients between two physicians or facilities. Providers who see and treat the same patients generally have a relationship of some kind, whether formal or informal.

RELATIONSHIP INSIGHTS

Beyond showing that relationships exist, patient-level data can shed light on how these relationships work. Physicians in the same practice, even in the same specialty, may focus on different conditions, treatments or procedures. For instance, physicians in the same orthopedic practice may specialize in conditions affecting a particular body part (such as knees or hips). By using patient-level data to analyze the conditions treated and procedures performed by each of the practice physicians, brand teams can better evaluate which physicians are of interest.

A number of market trends, including the introduction of Accountable Care Organizations and the growing number of clinics and outpatient facilities, have increased the need to understand formal and informal provider networks. The ability to monitor patient movement through the continuum of care, using patient-level data, gives brand teams insights into the more nuanced relationships between providers and helps explain the “why’s” of how patients move through the system.

FIGURE 1:

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