Latest / Becker’s Healthcare Podcast / How Healthcare Organizations Can Identify and Address Patient Leakage

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How Healthcare Organizations Can Identify and Address Patient Leakage · Becker’s Healthcare Podcast

• 0:00
  - Hello, everyone. This is Erica Spicer Mason with
• 0:02
  - Becker's Healthcare. Thank you so much for tuning
• 0:05
  - into the Becker's Healthcare podcast series.
• 0:08
  - So today's episode will explore how healthcare organizations
• 0:11
  - can identify
• 0:12
  - and address patient leakage,
• 0:14
  - which is when patients seek care outside of
• 0:16
  - their network,
• 0:17
  - and connect that to broader margin and strategic
• 0:20
  - planning goals.
• 0:22
  - And joining me for this conversation today, we
• 0:24
  - have two leaders at Deloitte. We have Eddie
• 0:27
  - Wilson, the managing director,
• 0:29
  - and Yuchen Chen, associate vice president.
• 0:32
  - Eddie, Yuchen,
• 0:34
  - great to have you both with Becker's today.
• 0:35
  - Thank you so much for making the time.
• 0:37
  - Thank you.
• 0:38
  - Thank you.
• 0:40
  - Well, before we get into the conversation, I
• 0:42
  - wanted to give you both the chance to
• 0:44
  - just to share a little bit more about
• 0:45
  - yourselves, your work in the health care space.
• 0:48
  - Eddie, do you wanna get us kicked off
• 0:50
  - here?
• 0:51
  - Sure. I'm Eddie Wilson, managing director out of
• 0:54
  - our Cincinnati office. I've been with Deloitte for
• 0:57
  - almost fifteen years now. Prior to Deloitte, I
• 0:59
  - was a mid mile defense attorney. So I've
• 1:01
  - literally spent my entire professional career working with
• 1:03
  - doctors in one capacity or another.
• 1:05
  - Because of that, I lead our physician enterprise
• 1:08
  - and ambulatory services group nationally as well as
• 1:10
  - our population health practice,
• 1:12
  - and spend a lot of my time really
• 1:14
  - building networks and then working with organizations to
• 1:17
  - try to keep patients within those networks.
• 1:20
  - I'll turn it over to Yu Chen.
• 1:22
  - Yep. Thanks, Eddie. I'm Yu Chen Chen. Actually,
• 1:25
  - by training,
• 1:27
  - work in Deloitte's San Francisco office.
• 1:31
  - Because of my training, I work a lot
• 1:32
  - with, health care data,
• 1:34
  - especially claim data all the time.
• 1:37
  - Because of that, I lead the design and
• 1:40
  - development of our care pattern analytics toolset,
• 1:44
  - and I support health systems in their care
• 1:46
  - retention and,
• 1:48
  - also with health plans on cost of care
• 1:50
  - improvement programs.
• 1:52
  - Happy to be with you today.
• 1:54
  - No. Thanks for for rounding us out with
• 1:56
  - the intros, Yuchen. It's great to have both
• 1:58
  - of your expertise on the line today.
• 2:01
  - You know, whether we're talking about the physician
• 2:02
  - enterprise, population health, and network integrity, but also,
• 2:06
  - Yuchen, your actuary training and your work with
• 2:08
  - health care claims data is going to be
• 2:10
  - especially
• 2:11
  - insightful, I think, as we're talking about leakage.
• 2:14
  - But I wanna do I I want to
• 2:16
  - start a little bit high level here. And,
• 2:18
  - Eddie, I'll I'll keep this first question over
• 2:20
  - to you.
• 2:21
  - I know you work with a lot of
• 2:22
  - health care organizations at Deloitte, and I'd love
• 2:25
  - to know where you're seeing patient leakage show
• 2:28
  - up the most. And how are you helping
• 2:30
  - leaders connected to their broader margin and their
• 2:32
  - strategic planning conversations?
• 2:35
  - Absolutely. And I I think I'll take the
• 2:38
  - back part of that question first.
• 2:40
  - So historically, we've had a lot of conversations
• 2:43
  - with health care leaders around margin, and there's
• 2:45
  - been a lot of concentration around the the
• 2:47
  - cost part of that equation.
• 2:50
  - And a lot of organizations have actually done
• 2:51
  - a really good job in terms of cleaning
• 2:53
  - up the cost component.
• 2:55
  - What they haven't been able to do is
• 2:57
  - actually focus on the revenue part of the
• 2:59
  - equation, and that's really where where patient leakage
• 3:01
  - comes in. So we have,
• 3:04
  - tools that we utilize in order to be
• 3:06
  - able to put data in front of, a
• 3:08
  - lot of times, CFO CEOs
• 3:10
  - to say, you have a patient leakage problem.
• 3:13
  - Almost every single time there's an agreement, they
• 3:16
  - know that they have the issue. They just
• 3:18
  - don't know exactly where it's coming from.
• 3:21
  - So we actually help them,
• 3:23
  - to really
• 3:24
  - pinpoint where the leakage is occurring.
• 3:27
  - And most of the time, it's holistic. So
• 3:29
  - it's it's occurring across the organization.
• 3:31
  - We break it down by service line. We
• 3:33
  - break it down by site of care,
• 3:36
  - to really get into the details.
• 3:38
  - To answer your question specifically, where we see
• 3:40
  - the most leakage on almost every single organization
• 3:42
  - is really imaging diagnostics and ASCs,
• 3:46
  - just because of the competition in the market.
• 3:49
  - There's generally a lot of leakage in those
• 3:51
  - particular areas,
• 3:52
  - but like I said, it it's really holistic,
• 3:56
  - and we use a lot of different techniques,
• 3:57
  - a lot of different services
• 3:59
  - in order to be able to
• 4:01
  - not only
• 4:03
  - address the pinpoint leakage issues, but address it
• 4:05
  - holistically across the organization.
• 4:09
  - Yeah. Eddie, I appreciate the overview. And when
• 4:11
  - you say the word holistic in this context,
• 4:13
  - it it definitely
• 4:15
  - brings to mind how important
• 4:17
  - being able to pinpoint where the leakage is
• 4:19
  - happening, how important that must be, and at
• 4:21
  - the same time challenging.
• 4:23
  - So, Yu Chen, I'll turn the next question
• 4:25
  - over to you. When you think about everything
• 4:27
  - that Eddie just laid out, what role do
• 4:30
  - data and analytics play in even getting to
• 4:32
  - this conversation about, you know, connecting leakage to
• 4:35
  - margin and strategic planning?
• 4:37
  - Yeah. Absolutely.
• 4:39
  - To I I'd say to move the needle,
• 4:41
  - right, on keepage and retention care retention,
• 4:45
  - first, we'd first have to agree on where
• 4:48
  - you stand.
• 4:49
  - And that's where I think analytics become essential,
• 4:53
  - in this journey,
• 4:54
  - not just to identify that key fudge is
• 4:56
  - a problem,
• 4:58
  - but to know, right, to to point pinpoint
• 5:00
  - where exactly.
• 5:02
  - For example, which service lines are leaking, which
• 5:05
  - side of care,
• 5:07
  - which type of care.
• 5:08
  - So so here's the thing. When we talk
• 5:10
  - to,
• 5:11
  - health system executives,
• 5:13
  - almost everyone
• 5:14
  - already knows keypad just a problem.
• 5:16
  - They feel it, but feeling it and knowing
• 5:19
  - it are different things. We want to move
• 5:22
  - them quickly from,
• 5:24
  - anecdotes to
• 5:26
  - fact base.
• 5:27
  - Think of it like a for example, like
• 5:29
  - a blood panel. Right? We
• 5:32
  - we go to doctors. We take blood tests,
• 5:34
  - and there's this blood panel.
• 5:36
  - It's usually not enough to know something's off.
• 5:38
  - You need to know that it's either cholesterol,
• 5:40
  - it's a one c, or it's vitamin d.
• 5:42
  - Right?
• 5:43
  - The diagnosis
• 5:44
  - drives the the treatment,
• 5:47
  - for our health care.
• 5:48
  - And,
• 5:50
  - same goes for,
• 5:52
  - sys you know, going about systematic changes in
• 5:54
  - in a health care organization.
• 5:56
  - Just like your doctors doesn't,
• 5:59
  - just run labs once,
• 6:01
  - you would come back, you retest,
• 6:03
  - and you track progress against your goals.
• 6:07
  - Analytics for Keepage works the same way. We
• 6:09
  - set the baseline, set the goals,
• 6:12
  - then keep measuring to make sure that, right,
• 6:14
  - you're actually moving towards the target.
• 6:17
  - Mhmm. So that's the the first overall point.
• 6:19
  - And, also,
• 6:21
  - the other thing that's worth understanding is that
• 6:24
  - a large health system isn't monolithic.
• 6:28
  - It's more like a big complicated family.
• 6:31
  - You've got dozens of provider groups under one
• 6:34
  - roof, and their alignment to the system can
• 6:36
  - actually vary wildly.
• 6:39
  - Take a clinically integrated network.
• 6:41
  - Some groups are fully aligned. They refer in.
• 6:45
  - They keep care in the system.
• 6:46
  - While others, they're
• 6:48
  - partially aligned in on paper, but quietly
• 6:52
  - sending specialized cases out of network or funneling
• 6:55
  - follow-up visits into their own ambulatory assets, which
• 6:58
  - we see a lot,
• 6:59
  - in our work with the clients.
• 7:01
  - So the data has to be structured in
• 7:03
  - a way that you can tell these groups
• 7:05
  - apart. Right?
• 7:06
  - Because the intervention for each one is will
• 7:09
  - be tactically very different.
• 7:12
  - Yu Chen, you're speaking my language here with
• 7:14
  - these metaphors. Force. This is so great. I
• 7:16
  - I love the comparison
• 7:18
  - between leakage,
• 7:20
  - you know, that difference in feeling
• 7:22
  - when patients are leaking and knowing exactly where
• 7:25
  - they're leaking from and kind of how that
• 7:27
  - relates to the concept of what we would
• 7:30
  - do with a blood panel.
• 7:31
  - And then also this large health system,
• 7:35
  - having that greater understanding of them,
• 7:37
  - likening that to a big complicated family.
• 7:40
  - Excellent metaphors here.
• 7:42
  - And it really all boils down to what
• 7:44
  - I think you're saying is addressing leakage is
• 7:47
  - really about being able to clearly
• 7:49
  - see where the problems are so that you
• 7:51
  - can address it swiftly.
• 7:53
  - So I'd love to know, Yu Chen, the
• 7:54
  - kinds of tools and capabilities that organizations
• 7:57
  - need right now to get that level of
• 7:59
  - visibility.
• 8:00
  - And from a data perspective, what insights do
• 8:02
  - leaders need before they can even take action?
• 8:05
  - Yeah. For sure.
• 8:07
  - I think it will need to be a
• 8:08
  - combination of internal
• 8:10
  - and external data.
• 8:12
  - And what I mean by that is is
• 8:13
  - internal referral data from the
• 8:16
  - EHR system
• 8:17
  - and external data. Usually, it's claims data.
• 8:20
  - And the claims data here that helps truly
• 8:22
  - paint the picture of what ultimately and actually
• 8:25
  - occurred.
• 8:26
  - Right? And
• 8:28
  - the internal referral data helps you to see
• 8:30
  - the the the patterns more tentative patterns more
• 8:33
  - timely,
• 8:34
  - and the claims data is a great complement
• 8:36
  - to paint a picture of of what actually
• 8:39
  - happened. The the capability needs to be able
• 8:42
  - to
• 8:44
  - identify and segment patients by cohorts
• 8:47
  - and, importantly,
• 8:48
  - examine the,
• 8:50
  - the full continuum of care that happens with
• 8:53
  - those,
• 8:53
  - right, with those patients in the cohort and
• 8:56
  - be able to,
• 8:58
  - I'd say create scorecards,
• 9:00
  - scorecard measures at various levels.
• 9:03
  - For example, can you do it, you know,
• 9:05
  - at an overall network level? Can you drill
• 9:07
  - down to specific group practices? Right? Can you
• 9:10
  - look at it by specific PCP groups, by
• 9:12
  - specialist groups?
• 9:15
  - Can you look at it by service line
• 9:17
  - and your different sort of your assets?
• 9:20
  - Because every system has its right? Has a
• 9:23
  - stronger presence, let's say, in a series of
• 9:26
  - service lines and maybe not not a strong,
• 9:28
  - like, weaker presence in some other service lines.
• 9:30
  - And it's important to know about that so
• 9:32
  - you can prioritize and focus appropriately.
• 9:36
  - Yeah. Really helpful overview, Yuchen. Thank you.
• 9:40
  - And, Eddie, I wanna check-in with you next.
• 9:42
  - Given what Yuchen just outlined here, can you
• 9:45
  - walk us through an example of when you've
• 9:47
  - seen a partner
• 9:49
  - implement this approach, you know, when they've really
• 9:51
  - been able to put insights into action and
• 9:54
  - turn leakage into an opportunity
• 9:56
  - instead? I'd love to know what that looks
• 9:58
  - like on the ground and from a retention
• 10:00
  - standpoint, outcomes that that partner may have seen.
• 10:03
  - Yeah. Absolutely. We've helped a number of different
• 10:05
  - organizations really improve the keepage percentage by at
• 10:09
  - least 10%.
• 10:10
  - A couple of specific examples,
• 10:13
  - where we've had a lot of success is
• 10:15
  - really where we focus on access. So access,
• 10:18
  - a lot of times, is the the number
• 10:19
  - one issue. Patients can't get in to see
• 10:22
  - a a particular specialist,
• 10:24
  - within a timely fashion. So we work with
• 10:26
  - organizations to really crunch their scheduling data,
• 10:29
  - to understand where there is
• 10:32
  - capacity that we can unlock really within their
• 10:35
  - existing footprint. So
• 10:37
  - we look at the actual scheduling data to
• 10:40
  - really understand our the providers meeting their clinical
• 10:44
  - FTE. So
• 10:46
  - you think of a provider needs to see,
• 10:49
  - on average, 36 patient facing hours a week.
• 10:51
  - And so we really look at
• 10:54
  - what is that provider doing across
• 10:57
  - the across the course of a week, and
• 11:00
  - we add all of that up to really
• 11:02
  - understand where the gaps are and say,
• 11:05
  - for example,
• 11:06
  - they might be at
• 11:08
  - 24 patient facing hours a week or 28
• 11:10
  - patient facing hours a week as opposed to
• 11:12
  - the 36. And then we work with organizations
• 11:14
  - to try to understand how do we close
• 11:16
  - that gap. So how do we put the
• 11:18
  - data really in front of the providers,
• 11:20
  - and have a very open conversation around how
• 11:23
  - can we open up this access because we
• 11:25
  - know you want to actually see these patients.
• 11:26
  - So let us help you,
• 11:28
  - work with your schedule in order to be
• 11:30
  - able to open that up so that we
• 11:31
  - can actually keep the patients within the network.
• 11:35
  - Yeah. Eddie,
• 11:36
  - really insightful, and I appreciate you sharing some
• 11:38
  - of those numbers, especially earlier in your response
• 11:40
  - highlighting that increasing retention by at least 10%,
• 11:44
  - a really compelling figure.
• 11:46
  - And, Eddie, as you look to the next
• 11:49
  - six to twelve months, what trends are you
• 11:51
  - watching most closely when it comes to network
• 11:53
  - performance and leakage?
• 11:55
  - And for a leader listening right now,
• 11:58
  - where is the highest impact place that you'd
• 12:00
  - recommend they start?
• 12:01
  - So what I'm really monitoring, and I've been
• 12:03
  - doing this over the course of the last
• 12:05
  - six to twelve months and will continue to
• 12:06
  - do that, is really the advancement in agentic
• 12:08
  - AI
• 12:09
  - and how that can potentially
• 12:11
  - help organizations in terms of care orchestration.
• 12:15
  - So as we look at other industries, they've
• 12:18
  - really done an excellent job in terms of
• 12:20
  - meeting the consumer where they are and making
• 12:22
  - it easy to do business.
• 12:24
  - Health care hasn't been able to do that
• 12:26
  - historically.
• 12:27
  - And what I'm trying to to do is
• 12:30
  - really create quick care orchestration platforms where you
• 12:34
  - meet the consumer where they are so they
• 12:36
  - understand how to navigate the health care ecosystem
• 12:39
  - so that it's easy for them to understand,
• 12:41
  - okay, where do I need to schedule an
• 12:43
  - appointment? How do I match
• 12:46
  - capacity
• 12:47
  - to the referral? How do I make it
• 12:49
  - seamless to actually do business with
• 12:53
  - my
• 12:54
  - health care system.
• 12:55
  - And to the degree that we can make
• 12:57
  - it easy, it creates stickiness for the consumer.
• 13:00
  - So they actually wanna do business with that
• 13:02
  - particular organization, and they wanna stay within that
• 13:04
  - particular network.
• 13:06
  - And it's beneficial to the system from a
• 13:09
  - revenue perspective, but it's also beneficial to the
• 13:11
  - patient because the care is actually coordinated,
• 13:14
  - and they actually ultimately end up getting better
• 13:16
  - outcomes as a result. So to the degree
• 13:19
  - that we can make it seamless, that we
• 13:21
  - can make it easy,
• 13:22
  - it's kind of a win win all the
• 13:23
  - way around.
• 13:26
  - Yeah. Eddie, appreciate that forward
• 13:29
  - looking,
• 13:30
  - statement about Adjantic. It's definitely aligned with what
• 13:34
  - we hear a lot of other leaders in
• 13:35
  - the space speaking to and what they're keeping
• 13:37
  - a close eye on.
• 13:39
  - Yu Chen, I wanna check-in with you before
• 13:40
  - we close. Is there anything else that that
• 13:43
  - you'd like to add on on here or
• 13:45
  - perhaps any points that you think that we
• 13:47
  - should have highlighted for our listeners and we
• 13:49
  - haven't yet? Yeah. Maybe just one more point,
• 13:52
  - and thank you for the for the question
• 13:53
  - there.
• 13:54
  - In terms of, of data and analytics,
• 13:58
  - apart from what I said just now,
• 14:01
  - we'd also frequently bring
• 14:03
  - in projections
• 14:04
  - on supply and demand in a specific market
• 14:08
  - that we look at by the different specialties.
• 14:10
  - And point of that is,
• 14:13
  - that we can have a good blend of,
• 14:16
  - right,
• 14:17
  - of retrospective review,
• 14:19
  - current state view, and also future projections.
• 14:22
  - Back to Eddie's point on access and
• 14:26
  - and the point on, network presence, right, footprint.
• 14:30
  - Do you have an access
• 14:32
  - problem now that needs to fix? And, you
• 14:34
  - know, if we look couple years down the
• 14:35
  - road as the population,
• 14:38
  - in in your market and and the right?
• 14:40
  - The patients that are visiting your system,
• 14:43
  - once that change, you know, as that changes,
• 14:46
  - are you well prepared
• 14:47
  - to meet the demand, right, where where they
• 14:49
  - are? And I think that will be an
• 14:51
  - important piece of the of the puzzle as
• 14:54
  - well.
• 14:55
  - Mhmm. An important point to highlight. Yu Chen,
• 14:58
  - thank you so much for closing us out.
• 14:59
  - And I wanna thank you both again for
• 15:01
  - making the time today.
• 15:02
  - Between your your deep work with providers and
• 15:05
  - in data and analytics in this space, I
• 15:07
  - feel like we we've left listeners with a
• 15:09
  - lot to think about here when it comes
• 15:11
  - to leakage and what data and analytics can
• 15:14
  - provide and what they can offer in terms
• 15:16
  - of change and progress. But, again, thank you
• 15:18
  - so much for making the time for Becker's
• 15:20
  - today. Thank you. It's been a pleasure. Yep.
• 15:22
  - Thank you very much.
• 15:24
  - And we'd also like to thank our podcast
• 15:26
  - sponsor for today, Deloitte.
• 15:28
  - Listeners, be sure to tune in to more
• 15:30
  - podcasts from Becker's by visiting our podcast page
• 15:32
  - at beckershospitalreview.com.
• 15:40
  - So what I'm really monitoring, and I've been
• 15:42
  - doing this over the course of the last
• 15:43
  - six to twelve months and will continue to
• 15:45
  - do that, is really the advancement in agentic
• 15:47
  - AI
• 15:48
  - and how that can potentially
• 15:50
  - help organizations in terms of care orchestration.
• 15:53
  - So as we look at other industries, they've
• 15:56
  - really done an excellent job in terms of
• 15:58
  - meeting the consumer where they are and making
• 16:00
  - it easy to do business.
• 16:02
  - Health care hasn't been able to do that
• 16:04
  - historically.
• 16:06
  - And what I'm trying to to do is
• 16:08
  - really create quick care orchestration platforms where you
• 16:13
  - meet the consumer where they are so they
• 16:15
  - understand how to navigate the health care ecosystem
• 16:18
  - so that it's easy for them to understand.
• 16:20
  - Okay. Where do I need to schedule an
• 16:23
  - appointment? How do I match,
• 16:26
  - capacity
• 16:27
  - to the referral? How do I make it
• 16:29
  - seamless to actually do business with
• 16:33
  - my
• 16:34
  - health care system.
• 16:35
  - And to the degree that we can make
• 16:37
  - it easy, it creates stickiness for the consumer.
• 16:40
  - So they actually wanna do business with that
• 16:42
  - particular organization, and they wanna stay within that
• 16:44
  - particular network.
• 16:46
  - And it's beneficial
• 16:48
  - to the system from a revenue perspective, but
• 16:50
  - it's also beneficial to the patient because the
• 16:52
  - care is actually coordinated,
• 16:54
  - and they actually ultimately end up getting better
• 16:56
  - outcomes as a result. So to the degree
• 16:59
  - that we can make it seamless, that we
• 17:00
  - can make it easy,
• 17:02
  - it's kind of a win win all the
• 17:03
  - way around.