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Referral networks: Looking for optimization opportunities

By Omar Nema, Senior Product Manager at Arcadia
Healthcare Analytics Medical Cost Containment Patient Engagement
Referral networks

Referral networks are built on complex patterns of decision making. Several factors feed into a referral — convenience, procedure quality, personal relationships, and others. Over time, these behaviors and inclinations cluster into patterns. Routes start to develop, and opportunities to optimize emerge.

To make sense of a large referral network, the artist started from the ground-up: by using a physical simulation to visualize each referral between a PCP and servicing provider. In the top figure, every referral (taken over a one-year period) is visualized as a line. Providers, represented as nodes, are pulled into their final positions based on the aggregate strength of all their referral relationships. Patterns in procedure referrals are readily visible, with streaks of out-of-network leakage coloring the graph.

At a smaller-scale, this approach to visualizing referral patterns can identify optimization opportunities. Through the x-ray breakout, the artist shares an example of an out of network servicing provider that occupies a market gap not yet covered by the network. To the right, the artist presents a network that is brimming with opportunities for re-routing. In this figure, primary care providers can be quickly identified that have strong connections to out-of-network and high cost services.


SQL, D3.js SVG, with Illustrator
Data sourced from Arcadia Benchmark Database with multiple EHR and Claims datasets