Market Insight concepts and terms for HME & Infusion – Edge

Market Insight is a powerful tool

Market Data is specific to data set(s) purchased by your organization and integrated into the Trella Health application. This information is generated from commercial and Medicare patient claims data. Our Market Insight data is composed of two main pieces: claims data and inferred data. As you may be aware, physicians and organizations are sorted into deciles like Order Rank, DX Rank, and Organization Rank, so that users are able to quickly identify high or low prescribing physicians. Additional data sets available in the market data include provider patient payer mix data

Market data is an optional feature available in Trella Health Edge. Market data contains historical detailed information about providers and facilities. These details include Order referral patterns plus market share information across providers and facilities in the post-acute market space. Commercial and Medicare claims data offer additional visibility into provider patient volumes and diagnosis trends to help marketing representatives know what providers can benefit from the services offered by the agency. Create your own value proposition using the market data in Edge!

Concepts and Terms

Claims data

The claims data is probably what you're most familiar with today. Providers and organizations bill for equipment and services through a medical claim. Trella Health data comes from a combination of commercial claims and Medicare claims information. Utilizing this information, referral patterns can be determined as well as patient volume per provider. In many cases the patient count values will align with the decile rank range, however when a referral source has patients across county or state lines these values may require further review. Data is updated every quarter keeping you informed of the most recent trends.

*The codes that make up the data in your Edge account are selected by your agency and have been determined to be high value for you when marketing.

Inferred Data

Many of the claims we receive for HME & Infusion do not have every field completed. Specifically, the attending and referring NPIs are often missing. Since our association of physician to organization is based on who is on the claim, when the attending or referring NPI is missing, we do not have anything to connect. Inferred Data is the process of finding associations between physicians and organizations to provide a better idea of the competitive landscape in your area.

Decile Ranks

Deciles provides a weighted ranking of the data to give perspective on the volume or value of the entity being ranked. To explain using the Physician Order rank, the total claims for the group of referral sources is divided into 10 equal portions. Referral sources that account for the highest volume of claims, or top 10% of claims, are given a ranking of "10", the referral sources associated to next highest volume, or decile of claims, are given a ranking of "9"; this continues until the lowest volume referral sources with the bottom 10% of claims are given the rank of "1".

Most decile rank values shown in the Trella Health Edge application are at the national level.

Order rank

This decile is representing the number of orders or prescriptions that the physician has written for one or more of the respective codes (equipment or medication) in the bucket. An example would be HME Oxygen supplies. A provider with a decile rank of 10 has one of the highest volume of orders for oxygen supplies.

Diagnosis Rank

This decile is representing the volume of patients the physician sees that have a diagnosis that is RELATED to one or more of the respective codes (ie: the patients who could use those type(s) of products). This can be viewed as the physician's potential to order these products. An example is a provider with a Diagnosis rank of 10 means she has a high volume of patients that have a diagnoses (potentially COPD) that are typical for patients who order or are treated with oxygen supplies.

Organization Rank

This is a decile rank representing the number of claims an organization received orders for or treated for the specific HME or Infusion product code in the dataset. An example would be HME Oxygen supplies. A provider with a decile rank of 10 has one of the highest volume of orders for oxygen supplies.

Payer Mix

Its important to understand what type of insurance the provider’s patient population has. If your organization only treats Medicare patients a provider with a high commercial payer mix may not be a high volume referral source. Payer Mix is not specific to the dataset, it is for the physician's overall patient population.

Other PCT - Represents patients without commercial or Medicare/Medicaid. This is typically cash or other benefit programs like Workman’s comp.
Medicare PCT - Percent of patients have Medicare
Medicaid PCT - Percent of patients that have Medicaid
Commercial PCT - Percent of patients that have a commercial policy. Its important to note that Medicare Advantage plans fall under the commercial bucket.

Physician & Organization Specific Data

Referral Share

Referral share is used to determine what volume of referrals and orders are going to what organizations.

% of referrals to Organizations

Represents the percent of all referrals a provider sends of his/her patient orders to an organization. An example- a provider orders 100 patients to have continuous home oxygen therapy. 25% go to organization A, 50% go to organization B, 10% go to organization C, 10% go to organization D, and 5% to organization E.

Organization Contribution Rank

Represents the referring physician's ranked volume of orders for the receiving organization. This can also be viewed as the value of that physician to that organization. For example if Dr. Jones sends 50%-75% of his referrals to HME company X, however his volume of orders is low compared to other physicians sending referrals to HME company X, his contribution rank will be low.

HCPC Codes

HCPCS codes are used to determine HME Market Data sets. A list of HCPCS codes used to create each HME data set are available in the provider details tab at the bottom of the Market data information.

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