As director of market research for Main Line Health, it's Anthony Stanowski's job to coordinate the research studies conducted by each of the hospitals. "Two of the hospitals have research analysts, but for the most part I'm the corporate resource for research. So although we contract out most research studies, the hospitals rely on me for opinions of research methodologies and vendors. It's a decentralized system. From the corporate standpoint there isn't a strong locus of control so we act as consultants for the hospitals," he says.
One tool Stanowski often uses in the health care system's many data analysis projects is computer mapping software.
For example, MLH was considering setting up a network of health care providers for its 5,000 employees. A loose network already existed, but MLH wanted to solidify contracts with some hospitals and eliminate others from the network. The analysis was intended to determine which hospitals to keep and which to drop.
Computer maps were created using Strategic Mapping Inc.'s Atlas GIS mapping software to show employee location by ZIP code, employee utilization of the hospitals by gross charges, and the location of competitors. "By looking at those three factors, two of them with strong geographic, spatial relationships, we were able to eliminate certain hospitals from the network. In one or two cases I think we added hospitals to the group that we want to contract with. One hospital wouldn't give us the discounts we were looking for so we found another one that could meet our needs just as well so we're negotiating with them to enter the network," Stanowski says.
Survey and clustering
When MLH wanted to investigate contracting with some managed care companies in its area, it used a system that incorporates a large scale survey and clustering.
The system, Mediedge, created by Inform Inc., combines data from a health care survey of 100,000 people around the country and Claritas' PRIZM clustering method. PRIZM identifies distinct demographic clusters, assigning each of them a name (such as Blue Blood Estates, Hard Scrabble, Young Influentials) based on their incomes, spending habits, where they live, etc.
"We take the utilization rates by cluster code, and although it's kind of a leap of faith when you say, 'Blue Blood Estates will have x percent of their population in HMOs,' it's probably the best thing we've got going right now to determine certain utilization rates in a small area.
Using Inform we're able to take estimates of managed care populations in specific ZIP codes or groups of ZIP codes. There's really no other way to get at that data."
Market share
In another analysis task, a Main Line Health member hospital wanted to investigate expanding its market share in certain areas as part of long range strategic planning. To start, Stanowski used Inform's AmPlan, a computer program that simplifies the forecasting of health care usage estimates.
"It applies local demographics to health utilization estimates based on the National Center for Health statistics; it tracks physicians in that area; and it takes practice statistics based on national norms. It uses all of these to give an idea of potential practice expense and revenue.
"For example, you define your area based on a three mile radius and you say, if we put a physician here and we penetrate the market by getting x percent of all patients we will have a net profit of x thousands of dollars by the third year.
"We used AmPlan to identify areas where we should consider placing physicians or enhancing practices and then we used Atlas GIS' pinpoint mapping to see the spatial relationship of physicians already in that area. That way, the CEO of the hospital can choose which physicians to recruit and which areas to place a physician in."
The mapping software also supported the efforts of Bryn Mawr Rehabilitation Hospital to refinance some of its bonds by illustrating the breadth of its service area. "Using Atlas GIS we were able to plot their primary, secondary, tertiary and regional referrals and define them in-depth. We were also able to map exactly where their competitors were."
Ongoing basis
Like many health care providers, Main Line Health uses patient satisfaction surveys on an ongoing basis to monitor the system's performance in a number of service areas. In addition, Main Line Health participates in annual studies as a part of a local hospital council. "We've used those studies to measure preference for one of our hospitals over the competition. Also, the hospitals use the studies to learn how to increase knowledge and awareness of their facilities through communications efforts based on the results of the surveys.
"Everyone likes to think they're on the cutting edge with their research, but I really believe we are. With the tools we have - Atlas GIS, Inform's Mediedge and AmPlan systems - and the way we're working with the managed care industry and looking at a wide range of service issues, I think we're doing some very interesting things."
Minimize risks
Stanowski says that Main Line Health is aware of the sensitive nature of information on an individual's health care, so steps are taken to minimize risks in data handling. "The hospital information systems departments are very conservative about giving out patient level detail. You have to balance the need to know who the consumer is versus the patient's right to privacy. Although there are benefits such as being able to do direct mail, the negatives of having that information outweigh the positives. So when we had to do some analysis of trends in our area and utilization by demographics we chose to go with a database based on scrambled social security numbers. It can be frustrating at times dealing with a database like that because you always want to know more but you have to weigh what could happen if that information fell into the wrong hands.
The many research projects the system conducts each year serve to maintain an efficient family of facilities providing quality health care at a reasonable cost, Stanowski says. "Our system tries to structure health care services to meet customer needs. Although quality is foremost and underlies all of our efforts, we try to distinguish ourselves from other quality facilities. For managed care, we position ourselves as lower cost, high-level care givers. We need to distinguish ourselves somehow and being a cost efficient provider is one way to do that."