CareJourney: Care Retention

CareJourney’s Care Retention data asset is the first comprehensive, value based care resource to map out your network utilization and referral patterns.

Large healthcare systems allow patients to access a broad and connected network of providers and facilities. In-network referrals form an important part of maintaining continuity of care across hospitals, primary care facilities, outpatient facilities, and adjuvant services to support better patient outcomes.

Health Systems Care Retention is a patient's continued and regular engagement with healthcare services at the same healthcare facility or system after the initial visit. However, there are scenarios when a patient pursues healthcare related services external to the health system or network. This can occur for a myriad of reasons, including out of network referrals, unsatisfactory patient experience and suboptimal patient health outcomes.

More often than not, this results in disruption of care continuity, lack of visibility of a patient’s journey, and in most cases, loss of revenue.

With over 2 million NPIs profiled, CareJourney’s data asset enables increased understanding of which groups are caring for your providers and where your providers have relationships. CareJourney’s data asset sheds light on these questions and more with 2M+ NPI utilization and leakage patterns profiled.

Data sources:
- CMS Medicare fee-for-service claims details
- Commercial claims details (add-on)
- Medicare Advantage encounters (add-on)
- CMS Physician Compare
- NPPES data

Each view (by year) is organized by:
- Provider x Provider (or Group Level)
- Provider x Facility

Sample fields include:
Demographic Metrics
- Referring Provider ID (NPI)
- Referring Provider Specialty
- Referred Provider ID (NPI)
- Referred Facility ID (CCN)
- Referral Type & Sub Type
- Referred Provider Specialty
- Facility Type & Sub Type
- Year
- Geographic Details

Premium Metrics
- Total Allowed Amount
- Number of Claims
- Number of Patients

搜集汇总

背景与挑战

背景概述

CareJourney的Care Retention数据集是首个基于价值的综合资源，用于映射医疗网络利用和转诊模式，帮助理解患者流失原因。它覆盖超过200万NPI，分析提供者与设施之间的关系，数据来源包括CMS医疗保险索赔和商业索赔等。数据集按提供者和设施组织，包含人口统计和高级指标，如转诊类型、索赔金额和患者数量。