Targeted, Data-Driven

Physician Outreach

Brian P. Borchardt, Director of Physician Relations

Baylor Scott & White Health

Today’s Discussion

• What metrics exist?

• Best practices - Scott & White, around the country, in this room!

• Hierarchy of data

• Leveraging data

– Retain referrals in your system

– Position your department as the go-to source

– Transform your program from good to great

1

2

DEPARTMENT OF PHYSICIAN RELATIONS – BAYLOR SCOTT &

WHITE CENTRAL DIVISION

• Department created in 2007

• 4 liaisons who are territory based

• 1 liaison directing internal outreach and communications

• 1 assistant/database administrator (works remotely)

• 3 homecare and hospice liaisons

• Both suburban and rural outreach

• Key Metric: Referral Increase (Primarily Outpatient)

• Referrals to Scott & White have doubled since the inception of

the program

• Highly leverage SalesForce.com database for program

metrics, reporting, and facilitation of referral processing

referral.sw.org

“Hierarchy of Data”

4

Results,

Aligned

with

System Priorities

Strategic Activity. “Voice of the

customer”

Activity

What do you track?

5

Metric ≤ 3 >3 ≤ 3 % >3 %

Visits 0% 0%

Physicians visited 0% 0%

Facilitation (doctor-to-doctor) visits coordinated 0% 0%

Market intelligence items submitted 0% 0%

Doctors remotely connected to EMR 0% 0%

Issues submitted 0% 0%

% issues resolved within specs 0% 0%

Emails collected 0% 0%

Newsletters sent 0% 0%

Physician surveys administered 0% 0%

Size of Program

(Number of

Liaisons)

Percent Who

measures

Current State

6

2013 Membership Survey Courtesy of

American Association of Physician Liaisons

www.physicianliaison.com

The Case for Results-Driven Programs

• Measures your true impact on the organization

• Drives your activities

• Ensures a focus on the things that matter

• Creates accountability for liaisons and program

• Allows for ROI calculations

• Routine tracking facilitates success

7

“Hierarchy of Data”

8

Results,

Aligned

with

System Priorities

Strategic Activity. “Voice of the

customer”

Activity

• Visits

• Physicians visited

• Facilitation (doctor-to-doctor) visits coordinated

• Market intelligence items submitted

• Doctors remotely connected to EMR

• Issues submitted

• % issues resolved within specs

• Emails collected

• Newsletters sent

• Physician Surveys administered

Huddle Board (Activity Measurement)

9

Huddle Board (Activity Measurement)

10

One Picture View

“Hierarchy of Data”

12

Results,

Aligned

with

System Priorities

Strategic Activity. “Voice of the

customer”

Activity• Surveys

• Ability to measure targeted activities

Survey ResultsStrongly

Agree Agree Neutral Disagree

Strongly

Disagree Score

Score - End

of FY'08 Change Rank

Last

Rank

It is easy to refer a patient to Scott & White. 25.47% 33.96% 7.55% 19.81% 13.21% 3.39 3.36 0.8% 8 7

The patients I refer are seen by a date that is

reasonable. 21.15% 36.54% 18.27% 16.35% 7.69% 3.47 3.29 5.5% 6 8

I am satisfied with the information I receive

regarding my patient's status/disposition. * 25.74% 41.58% 14.85% 10.89% 6.93% 3.68 3.38 9.0% 5 6

The physicians to whom I refer treat me with

respect. 45.33% 34.67% 16.00% 4.00% 0.00% 4.21 3.96 6.4% 1 2

I am confident that my patient will receive

quality care. 42.57% 39.60% 13.86% 1.98% 1.98% 4.19 4.06 3.2% 2 1

I'm confident my patient will be referred back

to me for care when appropriate. 38.00% 42.00% 15.00% 4.00% 1.00% 4.12 3.85 7.0% 3 3

Overall, my patient referral experience is

positive. 26.17% 38.32% 12.15% 11.21% 12.15% 3.55 3.49 1.8% 7 5

I would recommend Scott & White to a

colleague. 28.43% 40.20% 12.75% 8.82% 9.80% 3.69 3.69 -0.1% 4 4

I am satisfied with the information I receive

regarding the scheduling of appointments for

my patients * 20.00% 39.00% 13.00% 14.00% 14.00% 3.37 3.38 -0.3% 9 6

The Physician Relations Department helps my

practice access services and information related

to Scott & White 42.53% 31.03% 17.24% 2.30% 6.90% 4.00 n/a n/a n/a n/a

The Physician Relations Department is

responsive when I need assistance. 42.53% 32.18% 16.09% 4.60% 4.60% 4.03 n/a n/a n/a n/a

I value the information I receive through the

Liaison Letter, Scott & White's electronic and

print newsletter. 34.38% 39.06% 20.31% 3.13% 3.13% 3.98 n/a n/a n/a n/a

* The wording of this question has changed: Previous wording was "I am satisfied with the information I receive regarding my patient's status/disposition"

Leveraging this data

• Survey data

– Powerful. Leaders value this objective data

– Our case study: Improving the referral process

• Strategic Activity

– How many visits promoting strategic services?

14

“Hierarchy of Data”

15

Results,

Aligned

with

System Priorities

Strategic Activity. “Voice of the

customer”

Activity

• Market Share Data

• Average Daily Census – (Homecare/Hospice Census)

• Electronic Medical Record - Referrals

• Claims

(PRM systems can integrate most of these)

Foundational Data

16

Market Share Data

• Often resides in planning/business development departments

• Texas Hospital Association (Voluntary)• Texas Health Care Information Collection• Some states: State Medical Facility Plan

Utilization Data

• Many outside companies now process claims data

• Internally processed reports– Reduce delay: obtain data before it is sent to the state.

– Reports from hospital/clinic scheduling systems/EHR

– Reports from hospital billing systems

Using Data to Establish Programs

17

Priorities/Targets – Using Market Data

18

Physician Specialty

4 Qtrs CY

2004

3 Qtrs CY

2005

4 Qtrs CY

2004

3 Qtrs CY

2005

Total

Volume

2004

Estimated

Total

Volume

2005

Physician

Volume

Trend

Competing

Hosp.

Trend

Our Hosp

Trend

Our Hosp.

% Share

2005

Doc 1 Pediatrics 239 210 239 263 24 0 23.5 100.0%

Doc 2 Internal Medicine 67 315 67 394 327 0 326.75 100.0%

Doc 11 Family Practice 5 1 167 79 172 100 -72 -3.75 -68.25 98.8%

Doc 12 Oncology 3 1 155 77 158 98 -61 -1.75 -58.75 98.7%

Doc 13 Internal Medicine 6 1 72 61 78 78 -1 -4.75 4.25 98.4%

Doc 14Pediatric Hematology-

Oncology29 54

48 69 21 0 38.5 98.2%

Doc 63 Neurosurgery 24 8 134 111 213 199 -14 -14 4.75 69.8%

Doc 64 Family Practice 149 153 622 329 771 603 -169 42.25 -210.75 68.3%

Doc 65 Family Practice 54 96 201 187 255 354 99 66 32.75 66.1%

Doc 66 Neurosurgery 21 27 140 90 181 175 -6 12.75 -27.5 64.3%

Doc 67 Cardiology 84 23 62 37 146 75 -71 -55.25 -15.75 61.7%

Doc 68 Orthopaedics 38 21 75 29 113 63 -51 -11.75 -38.75 58.0%

Doc 69 Otolaryngology 4 2 11 4 17 9 -8 -1.5 -6 57.1%

Doc 70 General Surgery 52 50 129 59 181 136 -45 10.5 -55.25 54.1%

Doc 71 Cardiology 6 9 19 10 25 24 -1 5.25 -6.5 52.6%

Doc 72 Internal Medicine 73 65 125 70 198 169 -29 8.25 -37.5 51.9%

Doc 74 OB/GYN 493 397 429 310 922 884 -38 3.25 -41.5 43.8%

Doc 75 OB/GYN 59 229 50 157 109 483 374 227.25 146.25 40.7%

Doc 76 OB/GYN 458 340 470 215 928 694 -234 -33 -201.25 38.7%

Doc 77 Cardiology 41 21 47 26 128 94 -34 -14.75 -14.5 34.7%

Our HospitalCompeting Hospital

Priorities/Targets – One Method

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Criteria 1 Criteria 2 Criteria 3 Criteria 4 Criteria 5 Criteria 6

Physician Specialty

TOTAL

"Criteria

Points"

Physicians

in Strategic

Service

Lines

Loyal

Physicians

Who has

potential

for more

business?

High

Volume

Special

Requests

New

Physicians

Doc 1 Pediatrics 4 1 3

Doc 2 Internal Medicine 7 1 3 3

Doc 11 Family Practice 2 1 1

Doc 12 Oncology 2 1 1

Doc 13 Internal Medicine 1 1

Doc 14Pediatric Hematology-

Oncology 1 1

Doc 63 Neurosurgery 7 1 3 3

Doc 64 Family Practice 4 1 3

Doc 65 Family Practice 3 3

Doc 66 Neurosurgery 5 1 1 3

Doc 67 Cardiology 4 1 3

Doc 68 Orthopaedics 1 1

Doc 69 Otolaryngology 1 1

Doc 70 General Surgery 2 1 1

Doc 71 Cardiology 2 1 1

Doc 72 Internal Medicine 1 1

Doc 74 OB/GYN 5 1 1 3

Doc 75 OB/GYN 7 1 3 3

Doc 76 OB/GYN 5 1 1 3

Doc 77 Cardiology 5 1 1 3

Integrating Referral Data into CRM/PRM

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• Populated PRM database• Texas Board of Medical Examiners• Existing in-house physician data

• Worked hard to load referral information into the system

• Scott & White is unique and fortunate to be able to access outpatient data not available to most

• Contracted with a SalesForce partner, Astadia, to customize to our needs

• Had to identify the right internal resource with the right knowledge to make the whole thing work

• Referral data automatically loads into the CRM nightly, allowing us to access data rapidly

Foundational Data – Data

Considerations• Know all about your data

– How it is collected– What might cause inaccuracies– What human elements are involved

• You will be questioned about it – especially if it sheds a negative light on anyone!

• Stakeholders need to have confidence in reliability for data to be effective.

• If possible, take control of your data – don’t rely on others to do reports for you. Integrate data into PRM.

21

Priorities/Targets: Data Demonstrated

Key Drivers to Strategic Service Lines

Specialties Referring Patients to Cancer Services

Family Medicine 33%General Surgery 15%Hematology/Oncology 14%Internal Medicine 10%Cardiology 8%General Practice 5%Other 15%

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Destination of Referral Total % of Referrals

GI 97 14%

Orthopedics 75 11%

ENT 59 8%

Urology 55 8%

Podiatry 54 7%

Cardiology 44 6%

Ophthalmology 38 5%

General Surgery 37 5%

OB/GYN 33 5%

Dermatology 25 3%

Neurology 28 4%

Dermatology 25 3%

Plastic Surgery 23 3%

Pulmonology 17 2%

Allergy 15 2%

Audiology 13 2%

Endocrinology 11 2%

Other Specialties (less than 1%) 94 13%

Average annual

referrals from a

primary care

physician

Data Enabled a More Strategic Approach

24

Specialty Percent of Total

Referrals

Cumulative

Family Medicine/General Practice 56% 56%

Internal Medicine 11.8% 67.8%

Pediatrics 7.3% 75.1%

Emergency Medicine 3.7% 78.8%

Hematology/Oncology 3.3% 82.1%

Obstetrics & Gynecology 2.3% 84.4%

Optometry 2.1% 86.5%

Ophthalmology 1.7% 88.2%

Cardiology 1.4% 89.6%

Data Enabled a More Strategic Approach

25

Destination of Referral Total % of Referrals

GI 97 14%

Orthopedics 75 11%

ENT 59 8%

Urology 55 8%

Podiatry 54 7%

Cardiology 44 6%

Ophthalmology 38 5%

General Surgery 37 5%

OB/GYN 33 5%

Dermatology 25 3%

Neurology 28 4%

Dermatology 25 3%

Plastic Surgery 23 3%

Pulmonology 17 2%

Allergy 15 2%

Audiology 13 2%

Endocrinology 11 2%

Other Specialties (less than 1%) 94 13%

Average annual

referrals from a

primary care physician

Priorities/Targets:

Organizing Our Outreach

26

Priority & Potential Combination Expectation Weekly Monthly Yearly

75 High Priority, High Potential

Monthly Personal Meeting with office staff (unless remote),

every other month personal contact with doctor. 8.7 37.5 450

31 High Priority, Medium Potential Every-other month with doctor & office staff 3.6 15.5 186

6 Medium Priority, High Potential Every-other month with doctor & office staff 0.7 3.0 36

29 Medium Priority, Medium Potential Quarterly with doctor & office staff 2.2 9.7 116

30 High Priority, Low Potential

Quarterly Contact with Office, twice/year contact with

physician 1.2 5.0 60

15 Medium Priority, Low Potential Once/Year contact with doctor & office staff 0.3 1.3 15

15 Low Priority, High Potential

Quarterly Contact with Office, twice/year contact with

physician 0.6 2.5 30

50 Low Priority, Low Potential None 0.0 0.0 0

251 Total Total: 17.2 74.4 893

Meetings Generated

Number

of Docs

Scott & White Huddleboard– Referral

Impact Measurement

27

Goal Current Goal Current Goal Current Goal Current Goal Current

Liaison 1 22 28.89 5.0% 6.0% 1.4% 12.8% -1.6% 5.7% 3.0% -5.0%

Liaison 2 15 15.5 10.0% 8.0% 4.0% 6.0% 4.0% 6.0% 0.0% 14.2%

Liaison 3 22 32.47 -0.3% 3.0% 0.0% 4.2% 0.0% 6.9% 0.0% 4.8%

Liaison 4 17 16.13 -12.0% -15.0% 0.4% 8.8% -18.0% -17.0% 12.0% 45.9%

Top Practices

Referral

Increase

Weekly Meeting

Goal

External Referral

Increase

Internal Referral

Increase

Targeted

Referral

Increase

“Referral Retention” - Leveraging Other

Data from our EMR

• Issue – Lots of talk about leakage from employed primary care, but system never could quantify or provide actionable data.

28

Referral Retention - Key Activities

• Created the Role of “Internal Liaison”

• Received input from key physician stakeholders– CMO office and head of primary care.

• Integrated “Internal Referrals” into physician liaison goals

• Conducted Primary Care Focus Groups – “Communication and Opportunity”

• New communication tools: New Physician Email and “Bullet Notes”

• Data Analysis

– Received first data set from EMR

– Perform Quarterly analysis through pivot tables

– Painstaking process that including creating medical practice assignment rules based upon text boxes

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Referral Retention Process

1. Produce reports.

2. Analyze data, produce executive summary to call out key data

3. Meet with regional leadership to present information

4. Identify additional data needs and top opportunities

5. Develop and implement action plan1. Focus from liaison staff

2. Regional Physician Leadership discussed with individual doctors as necessary

6. Measure Results – Data updated quarterly

7. Agenda Item on Monthly Operating Reviews

30

Retention Efforts - Results

Region Baseline -

Average

monthly

referrals

leaving system

Baseline %

leakage

Latest Month

Measured - # of

referrals leaving

Latest Month

Measured - %

of referrals

leaving

Round Rock 210 5.6% 173 3.6%

Temple 189 2.3% 209 1.9%

Waco 216 17.6% 137 9.1%

Total 617 4.7% 519 3.8%

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Patients Retained – Annualized: 1,170

Annual impact: $785,749

Influence System and Reinforce Your Value – Share the Data!

• Issues

• Monthly Referral Reports

• “Market Intelligence”

32

Routine Reports

33

Report Description When Delivered FrequencyTime Period

MeasuredTo Whom

Referrals year to date vs. last year at

this time - Summarized by Facility

First Day of the

month - afternoonMonthly

Fiscal Year to-

date

B

B

P

Issues Report - Summarized by

Category and Department

First Day of the

month - afternoonMonthly Previous month

B

P

Stephen Sibbitt, Roy Smythe

Referrals year to date vs. last year at

this time - Summarized by Service Line

First Day of the

month - afternoonMonthly Previous month

B

Pryor, Glen Couchman, Roy Smythe

Physician Visit Intelligence Summary1st and 15th, each

monthTwice/Month Last 15 days

B

B

P

J

S

Individual Reports - Listing of

Physicians for each Service Line and

associated Referrals

September, March Twice/Year

Fiscal Year to-

date compared to

previous year at

this time

To Dept. Chairs and Division Chiefs,

G

UMC Referrals by External Physician

Grouped by Specialty and Resource

First Day of the

month - afternoonMonthly Previous Month

E

Dawna Kilpatrick, Dedra Bailey, Rob

Watson, Jeff Tramonte

UMC Referrals by specialty compared

to this time last year

First Day of the

month - afternoonMonthly

Fiscal Year to

Date

E

Dawna Kilpatrick, Dedra Bailey, Rob

W

UMC Issues Report - Summarized by

Category and Department

First Day of the

month - afternoonMonthly Previous month

E

Dawna Kilpatrick, Dedra Bailey

UMC Liaison - Previous two week's

Meetings

1st and 3rd

Tuesday of the

month - late

afternoon

Twice/MonthTwo previoius M-F

periods

E

Dawna Kilpatrick, Dedra Bailey

Previous Week's Meetings - Ray,

Samara, DedraWednesday a.m. Weekly Previous Week B

Progress toward goals - E-mails,

surveys, weekly meetings, meetings

with physicians

5th day of the

monthTwice/Month

Current Fiscal

Year

B

Samara Anderson

Insurance IssuesFirst Day of the

month - afternoonMonthly Previous Month

J

Schulte, Sharon Jarosek

Routine Reports

34

B/CS Specialty9/1/07 through

04/30/08

9/1/08 through

04/30/09Referral Change Percent

ADPSY - Adult Psychiatry 4 31 675.00%

ALLER - Allergy 26 30 15.38%

ANES - Anesthesiology 23 23 0.00%

CARD - Cardiology 121 135 11.57%

CD - Child Development 5 6 20.00%

CHOL 0 7 --

CIM - Community Internal Medicine 0 3 --

DERM - Dermatology 40 48 20.00%

DRAD - Diagnostic Radiology 1 19 1800.00%

ENT - Otolaryngology 85 108 27.06%

FMED - Family Medicine 105 176 67.62%

GER - Geriatrics 1 0 -100.00%

GI - Gastroenterology 77 143 85.71%

GSURG - General Surgery 52 56 7.69%

HEMON - Hematology/Oncology 0 4 --

NEPH - Nephrology 0 1 --

NRAD - Nuclear Radiology 2 0 -100.00%

NSURG - Neurosurgery 3 3 0.00%

OBGYN - Obstetrics/Gynecology 151 278 84.11%

OPHTH - Ophthalmology 33 32 -3.03%

ORTHO - Orthopedics 64 96 50.00%

PCARD - Pediatric Cardiology 25 23 -8.00%

PENDO - Pediatric Endocrinology 45 47 4.44%

PGI - Pediatric Gastroenterology 58 69 18.97%

BCS Referrals Comparison - External Referrals

Previous Fiscal YTD vs. Current Fiscal YTD

What about PRM?

35

Product 2009 2010 2011 2012 2013

Crimson 26% 15% 20% 8% 21%

Marketware 14% 25% 20% 15% 19%

SalesForce 3% 2% 15% 12% 15%

In-house built 26% 15% 20% 18% 8%

ACT 21% 19% 16% 8% 7%

Microsoft CRM - - 10% 6% 9%

SalesLogix - - 4% 3% 2%

LVM 3% 2%

Evariant/HealthConnect - - - 2% 3%

CPM/Healthgrades - - - 2% 2%

Zoho - - - 2% -

Do not use PRM 36% 40% 14% 23% 15%

n= 72 48 69 66 117

Courtesy of

AAPL

2000 B.C. - "Here, eat this root."

1000 B.C. - "That root is heathen, say this

prayer."

1850 A.D. - "That prayer is superstition,

drink this potion."

1940 A.D. - "That potion is snake oil,

swallow this pill."

1985 A.D. - "That pill is ineffective, take

this antibiotic."

2000 A.D. - "That antibiotic is artificial.

Here, eat this root."

~Author Unknown

(Kindly borrowed from a previous co-presenter, Christine Perry, Duke Medicine!)

A Short History of Medicine

Results,

Aligned

with

System Priorities

Strategic Activity. “Voice of the

customer”

Activity