Are You Letting Half of Your Revenue Slip Away?

Did you know that patients—who know you, trust you and chose you—are quietly walking out the door to your competitors?

In today’s market, it’s rare for a health system to capture more than 50% of a patient’s share of care. Even among systems with loyal patients and high-functioning teams, more than half of the revenue opportunity is silently slipping away—undetected, unmanaged and unclaimed.

Growth, Margin and the Missing Link: Why Now?

For more than two decades, health systems have battled leakage and margin erosion—especially within high-value service lines like orthopedics. But today, the stakes are higher than ever. Legislative shifts, including the sweeping implications of the One Big Beautiful Bill Act, have intensified financial pressures across the industry. Health systems now face heightened accountability; tighter margins; and increasing demands for transparency, value and coordination.

What were once nice-to-have tools are now urgent strategic imperatives. Traditional approaches to margin protection are no longer sufficient. Leaders must proactively recalibrate their long-term road map using tools that reveal the full picture and empower faster, smarter interventions.

Whether you’re leading strategy, finance, network development or service line planning, the expectations are clear. To succeed in today’s tough market, you need to:

• Grow volume of patients and visits.
• Protect margin.
• Retain high-value patients.
• Optimize resource allocation.

A Real-world Breakdown: When Orthopedics Margin Starts to Slip

At a midsized regional health system, executives spotted an unexpected issue in their year-to-date performance dashboard: orthopedics—historically one of the organization’s most profitable service lines—was barely breaking even.

Margin had been steadily eroding, but frontline metrics told an incomplete story. Surgical schedules looked full. Physician productivity seemed stable.

Initially, the team turned to familiar levers:

• Increase marketing to raise awareness.
• Expand access points to drive volume.
• Dissect surgical scheduling for efficiencies and increased throughput poised for backfill.

But none of these approaches addressed the bigger issue. What was actually happening across the full patient journey?

How Claims Data Tools Revealed the True Issue

By leveraging the advanced claims-powered tools offered by Vizient®, the system moved beyond siloed reports and evaluated the full continuum of care, from imaging to physical therapy to surgery and post-op.

That’s when the real problem emerged: the referral pipeline between orthopedics and physical therapy was fractured. Patients were being handed off inconsistently, often diverted to external providers, with little follow-up visibility. As a result, many patients never completed their care journey within the system, which increasingly meant they were accessing follow-on and net-new care with the competition.

The hospital wasn’t just losing encounters—it was losing lifetime value.

This issue wasn’t isolated to the ortho service line. Without the benefit of viewing operations through a strategic, claims-based lens, traditional levers like marketing and recruiting added strain without fixing the leak.

Meeting the Moment: How Modern Claims-Based Solutions Solve the Conundrum

Today’s financial reality demands more than yesterday’s leakage analytics. A full complement of claims-based solutions—traditional leakage detection, full-journey analytics and loyalty intelligence—has become the cornerstone of competitive strategy.

These tools can evaluate:

• Share of care (full-site market share).
• Leakage/keepage.
• Share of wallet.
• Customer churn rate.
• Patient lifetime value.

These actionable insights drive strategy toward retaining patients and protecting margin. Yet few vendors offer this breadth of capabilities, and fewer still provide the strategic blueprint to pull it all together, quickly and effectively.

Vizient tools go beyond the technology to leverage in-house experts who function as opportunity modelers, surfacing insights, delivering strategic lift and providing actionable next steps. These opportunity experts work alongside member organizations to interpret findings (the “what”), prioritize interventions (the “why”) and act (the “what now”). Translating cost, quality and market insights into prioritized actions drives immediate performance gains anchored in the patient journey. Whether that’s fixing a broken referral pattern, optimizing care design or improving site-of-service alignment, these tools help you understand and change.

This comprehensive approach is a unique Vizient differentiator, enabling:

• Strategic retention of high-value patients.
• Clear visibility into critical system performance.
• Cross-functional alignment across strategy, finance, network and clinical operations.

This integrated view helps leaders not only identify leakage but also optimize care design, inform growth strategies and improve patient outcomes over time.

From Data to Direction: Strategy That Moves

In a world where growth is hard won and margin pressure is relentless, the ability to see the whole patient journey—and act on it—is no longer optional.

Visibility is step one. But transformation comes from action. Vizient’s modern claims-powered tools empower health systems to see what’s really happening, understand why and act quickly on the insight.

When you close those visibility gaps, you secure revenue, protect margin and retain patients for the future.

Sources: Proprietary Sg2 All-Payer Claims Data Set; IQVIA; Sg2 Analysis, 2024.