The Keepage Conundrum:
Why Domestic Utilization is So Important

Our mission is to accomplish the triple aim of healthcare while developing a culture to support and create increasing value for physician practices in our community. Through healthier patient and physician practices, Beacon’s ultimate goal is to achieve a healthier population.

That is our mission. But, what do we mean by developing a “culture to support and create increasing value for physician practices in our community”? Well, there are many ways in which we try to bring our physicians value. We do this with our managed care contracts in the form of enhanced rates tied to quality, shared savings opportunities, consultative services that improve office workflow, decreasing practice costs by brokering a host of strategic partnerships, educational opportunities through Beacon University… but, another way to bring value to Beacon physicians is by increasing our domestic utilization (DU). Improving domestic utilization is also known as increasing “keepage” (or decreasing leakage). Frankly, we have struggled in this area. We simply need to do better (Figure 1).



Domestic utilization (DU) is defined as the amount of healthcare utilization that occurs within Beacon. This includes referrals to Beacon physicians, and Beacon in-network hospitals and facilities. Our goal is to markedly improve our domestic utilization.


1. Beacon Community Growth- With more consistent use of Beacon providers and facilities, communication channels, data exchange and comfort all increase. Coming closer together or becoming a more tightly-knit community increases our chances of executing on all our initiatives.

2. Beacon Physician Economics– increased use of Beacon providers drives the right volume and revenue to our members. When our population utilizes non-Beacon physicians, we, quite literally, miss out on millions of dollars. Our practices would be better off financially if more of the necessary utilization and associated healthcare spend was kept within the Beacon family.

3. Beacon Partner Value- increasing the use of in-network facilities and hospitals not only improves the health of our partners, it can improve communication and transitions of care. This can lead to better, more efficient care that benefits our patients, our physicians and the entire organization. Also, the more value we create for our partners, the stronger and mutually beneficial our partner network becomes, and we are better positioned to engage in additional strategic partnerships.

4. Recruiting Advantage- The attractiveness of “keeping it in the family” extends beyond our existing network. Just as many of our current providers would prefer more intra-Beacon referrals; potential new members would find high domestic utilization to be a very appealing feature of Beacon. This would help in our efforts to recruit and grow our network.

5. Higher Quality- Beacon has high quality standards and outcomes. We are excelling on many quality measures and are actively closing clinical care gaps. Keeping patients within Beacon is likely to lead to even higher quality as we work together in a more coordinated fashion on shared quality initiatives.

6. Population Health Outcomes- It is easier to manage patients in our population if the patients are kept within our network. Relationship building between Beacon physicians and in-network facilities will yield greater efficiency and improved outcomes. Additionally, higher DU results in enhanced interaction with Beacon CareNation and the rest of the Beacon support team.

7. Shared Savings Bonus Growth- The better we manage our population, the more likely we are to realize greater savings, which may lead to higher shared savings bonuses for everyone. Moreover, non-Beacon providers and facilities are often more costly. So, in addition to adversely affecting our ability to manage our population, non-domestic utilization may have a higher per unit cost, which eats into a potential savings bonus.

8. Improved Managed Care Contracts- Realizing higher quality, generating more savings within in a bigger, tighter knit network would send a powerful message to the managed care payors. Our success in this endeavor could allow us to achieve even bigger, better managed care contracts for everyone.

These benefits are related and build upon each other (Figure 2).



We are using our population risk management tool, Crimson (CPRM) to comb through our Medicare claims data on an ongoing basis. Each expenditure is categorized as either domestic or non-domestic, according to the source of the claim. We have created a metric which we are now tracking for the organization as well as for individual physicians who are attributed lives in the MSSP. Our goal is to increase utilization within the Beacon network.


The domestic utilization scores are presented in the dashboard of physicians who have more than 50 attributed MSSP lives. DU makes up 50% of the overall utilization score in the QUAC metric (the other 50% is emergency room utilization). Higher DU leads to higher QUAC scores and higher QUAC scores lead to higher shared savings bonuses for the member. See our QUAC and Shared Savings Distribution videos.


Expect data driven feedback (tracking DU scores) and a greater organizational emphasis on increasing domestic utilization. We have also had some preliminary discussions with physicians to solicit feedback and participation in a DU Task Force to tackle this issue head on. If you wish to join us, please contact me at

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