Out-of-Network Patient Migration

Value-based healthcare organizations are responsible for out-of-network costs when calculating risk scores, benchmarks, cost reduction as it relates to minimum shared savings rate (MSR) and health outcome improvement based on quality metric score, re-admission rates or gaps in care completion rates. So, it's important...

2.5 Million Medicare Patients

Our analysis of 2.5 million de-identified patients, indicated the average cost of One patient going out-of-network was:

Part A: $2,400 per year

Part B Physician: $1,350 per year

Part B DME: $300 per year

Projected Annual Revenue Loss

Projected Annual Revenue Loss to Out-of-Network Migration for a health system:

 Part A: 33%

 Part B Physician: 53%

 Part B DME: 85% 

Revenue an organization could have kept in-network cost controlled and achieved better health outcomes.

Manage Out-of-Network Migration

Your team needs to use your claims data to identify:

Who:  Patients & Diagnoses

What:  Procedure & Visit Types

Where:  Out-of-Network Facilities 

When:  Timing of Referral

How:  Providers referring patients out-of-network

Define and Communicate

Providers in a value-based program need to know which providers are in-network so they can assist in controlling costs and improve patient health outcomes. While the patient may choose any provider, the benefits of in-network care programs have proven extremely beneficial to cost reduction and health outcomes.

For technology solutions - Contact Kris Gates, CEO, Health Endeavors, [email protected], 480.659.8130