healthcare continuum of care diagram

Recent health care mandates have only intensified the need for health care organizations to measure and quantify patient outcomes and total cost of care rendered across the health system. As organizations transition to value-based reimbursement models, health care executives are putting aside anecdotal evidence for the objective, data-driven insights obtained through downstream analysis.

Health systems typically lose an excess of $100K annually per employed physician. As a result, many hospitals contemplate divestment of employed physician groups to offset loss. However, what health systems need to recognize is the value generated by downstream revenue including inpatient admissions, outpatient visits, and ancillary services will typically more than offset employed physician loss.

Downstream analysis provides a practical way to assess revenue generated across the continuum of care by identifying the value created for a patient over the full cycle of care, including all provider interventions – office visits, inpatient services as well as ambulatory services. This analysis measures, tracks, and quantifies value all the way down to the patient level. Its patient-centric view provides visibility into outcomes relative to all costs associated with care. Patient outcomes and costs can be tracked longitudinally, over various entry points and multiple time periods.

In addition, downstream analysis provides insights pertaining to both operational and strategic planning initiatives. At an operational level, downstream analysis can focus on clinical pathways, referral patterns, and patient flow. For instance, a health system can use downstream analysis to learn the most common pathway taken by all patients with congestive heart failure following the initial visit. This patient-centric tracking allows health care providers to see how patient care is progressing and whether or not the interventions implemented are yielding positive outcomes. Downstream insight is invaluable for making informed strategic decisions impacting not only patient care but the health system’s growth and financial livelihood.

Strategically, downstream analysis provides insight into the financial return on investments and potential growth. Furthermore, it informs physician acquisition, alignment, and performance management initiatives. Additionally, it allows for the accurate measurement of a physician’s impact on cross-continuum revenue, the identification of opportunities for improvement, and the development and implementation of changes to improve physician-hospital alignment. For example, one health system believed they had over extended themselves when they realized they were losing over $558K annually for a group of physicians. As a result, they were tempted to divest this group in order to cut their losses. However, by means of downstream analysis they discovered physician divestment would actually cost them $9M in operational margin. Downstream analysis enabled them to rank their primary care groups based on productivity and profit margins generated to measure and quantify the true value of their employed physician groups.

Downstream analysis makes it possible for health systems and hospitals to focus on efficiency, cost effectiveness, and quality that will inevitably bring about successful value-based care. It empowers health care systems to accurately measure and quantify the downstream value of an employed physician, point-of-care location, service area, marketing campaign, or other patient point of entry. If you haven’t experienced the power of downstream analysis, now is the time. It’s an asset that will help blaze the trail to increased revenue and profitability for your health system.

To learn more about downstream analysis, download our white paper titled "A Guide to Downstream Analysis" or visit the nThrive Analytics Downstream Analyzer page.