Turning Claims Data into Dollars

Turning Claims Data into Dollars

Many leaders would fail to argue that there is no value in data; a multitude would more likely argue data as one of the most valuable assets to their organization. However, addressing how this data becomes a narrative that translates into ROI is a conversation we need to have. This past week, Salt Lake City hosted another successful Silicon Slopes Tech Summit. Shantanu Narayen, CEO of Adobe, gave an educational talk on the importance of constantly looking at data to see if it supports your organization’s hypothesis. Narayen discussed the urgency to have a strategic story supported by data as well as the urgency to have data supported by a strategic yet simple story. Data should ultimately be used to drive actions and support decisions that address goals and issues of an organization. Through aiming to make data actionable, organizations can grow beyond measure.


Why Teams are Moving Toward a Data Driven Approach

Businesses and organizations are well underway of utilizing data to increase ROI. Without data, hospitals, health systems and medical groups lack the insights needed to fully understand their referral base, leading to unreliable network connections, potential physician misalignments and, ultimately, limiting growth. Utilizing data into a strategic plan supports the development of stronger static priorities, focuses outreach resources where they add the most value, provides foundational support needed to build and redirect a facility’s referral base, and increases the ability to measure and effectively communicate ROI of outreach activities.

The data driven approach allows organizations to understand what Marketware calls, “The 8P’s of Data Driven Development”:


  • Products that perform: Which services define your organization?
  • Position in the market: Where you stand in market as compared to peers?
  • Profitable volumes: How can you focus on growing “good” volumes?
  • Patient Pipelines: How do patients get to your organization?
  • Physician Alignment: What impact do formal/informal connections have?
  • Prioritization: How do you quantify & rank growth opportunities?
  • Planning for progression: What actions need to be taken to advance relationships?
  • Proving Returns: How can you show impact of your outreach efforts?


For example, through utilizing a data driven approach, an organization can “connect-the-dots” of their organization through unique patient identifiers, highlighting shared patients between two or more providers with specific time frame. This example suggests a potential patient pipeline which allows an organization to begin a narrative through data.


Understanding Claims Data

In a poll completed by Marketware, 52% of organizations reported that insufficient data is the greatest challenge their organization faces leveraging claims data. Claims data puts information in the hands of your business users, so they can answer questions revolving around rotating key competitors as well as competitors in specific markets and services. Claims data is also able to tell you top performing providers, give you referral data, insight into the size of potential opportunity in the market and the size of ROI of specific service offering partnerships. Having a customized tool that not only gathers data, but organizes said data, gives you a holistic, full-picture view of performances, connections, opportunities, and threats.

The failure to understand claims data often results in limitations that negatively affect your organizations use of claims data. It is imperative to understand that external claims offer approximately 70% capture (national average) based on practitioners’ region and web services utilized. Therefore, claims data is meant to supplement your internal data sets, not replace them. Instead, claims data is meant to provide directional analysis or market share and referral connections. Lastly, it is important to understand financial projections from claims data is an estimate and each organization can have a unique process.


The Important Involvement of Dashboards in a Data Driven Strategy

External claims dashboards in Scout are designed to help organizations visualize and better understand their competitive landscape at the service line, network, provider and procedural levels. Use of Scout’s procedural dashboard, can uncover a specific service line and/or key competitors. From there, business development teams can understand which potential referral partners are tied to their aligned providers and how to reinforce these ties. Development teams can also use the data to understand which potential referral partners are tied to providers aligned with the competition and how to best influence these ties over time.

An effective dashboard should include flexible tools that aid in the customization of data insights, enabling at-a-glance competitor assessments and comparisons – drillable interactive dashboards, and custom views. Customizable tools aid in deeper insight into marketing trends. Subject matter experts are therefore empowered to identify opportunities themselves that are more applicable rather than using a static report tool.


Closing Thoughts

While data as a significant source has been recognized by many CEO’s, realizing how this data can create and support a narrative for further organizational growth is imperative. Through using a data analytics platform, organizations can set and alter their narratives to better reflect specific questions and goals. As creating a strategic plan backed by data becomes apparently more detrimental to increasing ROI, the need for customizable tools on data analytics platforms that allow deeper market insight grows as well. Utilizing claims data correctly and efficiently can result in tremendous growth of an organization.