Patient Journey Mapping

What Is Patient Journey Mapping?

A patient map is a blueprint for each point of contact between healthcare professionals and their customers. Patient journey mapping is essential to understanding what factors influence a patient’s medical costs within your healthcare system. By strategically examining the various aspects of a patient’s journey, healthcare professionals can discover what causes differences in price between their services and those of a competitor. Each point on our maps provides the information needed to adjust costs based on newly acquired patient information.

Our patient journey maps will determine key metrics that influence the course of a patient’s journey. Modus Health Group’s data will help you to understand these areas and make smarter pricing decisions accordingly.

In the competitive healthcare sector, patient journey mapping and cost adjustment are valuable methods for maximizing the efficiency of the healthcare resources at your disposal. For example, patient journey mapping for orthopedic knee surgery is typically focused on five important stages: evaluation, pre-surgery, surgery, post-surgery/discharge, and physical. Knowing the ins-and-outs of each of these stages can lead to happier patients and boosted profits.

What Questions Can Patient Journey Mapping Answer?

  • How can we increase our market share in primary services?
  • Why are orthopedic/cancer/cardiovascular/neurosurgery visits declining?
  • What differentiates us from our regional competitors?
  • How can we promote strategic growth as a geographically contiguous health system?
  • What can our facilities do to enhance consumer engagement and customer experience?
  • In what ways can we engage in better clinical and economic integration with physicians?
  • How can we improve value and affordability for the patient without sacrificing profit?
  • How does our risk-bearing inform pay-for-performance incentives?
  • And countless more!

The Five Areas of Patient Mapping:


Our data will reveal the ways in which doctor specialty and demographic elements impact the initial cost of an office visit. Analyzing demographic differences between patients provides a foundation for understanding cost gaps between facilities.

The variables we have identified as influential factors for evaluation are patient diagnosis, number of visits by the patient, and comorbidities.


In order to understand how pre-surgery expenses, impact the final cost of the procedure, it is necessary to quantify and analyze the metrics surrounding types of treatment. Differing quantities for these metrics will identify unique patients and patient types which, in turn, inform cost. A patient demographic that requires a greater number of tests will naturally incur higher costs.

The variables we have identified as influential factors for pre-surgery are number of lab tests, x-rays, and prescribed medications to patients.


Cost differences for knee surgery are determined by several metrics that will be unique to each healthcare system. For example, patients that have surgeries performed at a high-volume medical facility by specialized doctors may see higher costs per procedure

The variables we have identified as influential factors for surgery are location type (hospital or ASC), doctor specialty, and volume of surgeries.


The patient cost for post-surgery and discharge depends on metrics regarding issues that occur after the operation. Evaluating these metrics sheds light on costs related to length of stay and patient risk. Patients at higher risk for readmission will cost more than lower risk patients without complications. This is a key driver of the cost difference between similar facilities that depends on patient demographics and risk.

The variables we have identified as influential factors for post-surgery/discharge are complications and probability of readmission.

Physical Therapy

Patients that require additional care following surgery will incur additional costs for these services. This stage of the patient’s journey is most heavily influenced by factors from previous stages. The costs accrued from the past four steps will contribute to the final cost of the patient’s treatment.

The variables we have identified as influential factors for physical therapy are need for rehabilitation and number of extended recovery days.

Factors That Influence Variance in Patient Care:

Patient demographics, insurance type, and patient comorbidities all play a significant role in determining the final cost of a successful medical procedure. Each of these factors influences variables such as the diagnosis, procedure, service date, and length of stay, which all influence total cost.

Gender, race, age, marital status, employment, and education may impact the cost of procedure for a patient. Investigating how these traits impact patient experience can yield valuable information needed for adjusting the cost of procedure.

Any pre-existing or chronic conditions a patient may have, as well as their medical history, may affect treatment cost. Our years of experience interpreting nationally projected medical trends across the U.S. helps us to understand the importance of comorbidities.

The copay and insurance type may influence the cost of procedure. Modus Health Group has worked with data from some of the largest insurance companies in the U.S. to interpret how insurance differences impact patient procedures and net revenue per patient.


Our data shows that patients in the 77055 ZIP mirror the general Houston population by being at higher risk for primary hypertension as opposed to the other variants. With the proper patient, geography and facility information, we can determine the cost for a 49-year old man with diabetes and hypertension for the 77055 ZIP.

Table A. Local ZIP

Risk Markers for 77055Risk Weight
Male Age 49.42
Type-1 Diabetes1.4
Primary Hypertension3.1

Table B. General Population

Risk Markers for TOTALRisk Weight
Male Age 49.22
Type-1 Diabetes.8
Primary Hypertension1.4

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