Referral Management - New Solutions for a Perennial Challenge

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By Dr. Dave Levin

Work in healthcare long enough and you start see certain issues as perennial favorites. There are two factors that contribute to the “popularity” of these kinds of “favorites.” First, they are important clinically or financially, or both. Second, they include stubborn problems that are resistant to change. Ask a seasoned healthcare veteran and they can probably reel off a series of them.

One of the classics is referral management. I’ve been watching organizations pursue this one for most of my career. Conceptually, the idea is simple: design networks of care that can efficiently route patients to the right providers with the right information in the right sequence. These networks can be formal and closed like a panel of approved providers within an insurance plan or accountable-care organization or they can be informal and open like the typical primary-care to specialty care provider referrals. Surprisingly, owning practices or being a multi-specialty group does not automatically result in good referral management. I’ve even seen multi-specialty practices that owned their very own labs, imaging and ambulatory surgery centers struggle to keep referrals from going outside their own group. Talk about leakage!

Healthcare organizations, be they providers or payers, care about these referral networks and patterns deeply. They want patients to get quality care and be satisfied. They want providers to be efficient and operating within the boundaries of their specialty and knowledge. And, of course, they want to capture as much of the revenue that flows from these processes as possible. Narrowing and managing networks is a key strategy in pursuing the triple-aim.

Ask any clinician and they will tell you essentially the same thing about sending patients for other services. They want their patient to get quality care and be treated nicely. They want to know what happened and what they need to do next. They want their patient back. And, they want all this to happen as seamlessly as possible with minimal impact on them or their busy staff.  Those accepting referrals have similar desires. They want patients who fit with and need the services they provide. They want to know why the patient was referred and what has been done previously. They want patients to have had appropriate primary evaluations and treatment before progressing to specialty services. And, they too want to minimize impact on them and their staff.

So, if this is an important problem and big opportunity, why has it proven so stubborn? While there’s no question there are a number of factors – resistance to change, personal preferences and relationships, legitimate concerns about quality within a network – I think it mostly boils down to being “Easy To Do Business With” (ETDBW). Organizations that are ETDBW focus on making it as easy and efficient as possible for others to work with them. This entices, delights and retains customers. As long as they maintain quality and service, they become the de facto provider of choice.

I’ve lost count of the number of times I worked on projects to increase internal referrals for services like radiology for a health system only to see the business continue to flow from their clinicians to a local competitor. Ask them why and the answer is some version of ETDBW: “They bend over backwards to work my patient into the schedule. They always send back a great report and even have a way for me to see results online. I always get my patient back and they are usually happy.”

I was reminded about all of this recently while working with several of our digital health and health system customers. In one case, a health system is suffering leakage of referrals for diagnostic testing because it does not provide an easy way for the referring MD to get results back. Are you kidding? There’s no way I am going to send lots of patients to you if you can’t tell me what you did! In this case, we’re working with them to deploy a portal that seamlessly integrates with their EMR so clinicians can easily retrieve the results of that lab or imaging study they sent the patient over for. By making it ETDBW, they will see an increase in referrals, revenue and satisfaction.

In another example, one of our digital health partners has a really nice referral management system that expedites the scheduling and information flow in support of the typical referral. They are now leveraging our APIs to integrate this platform directly with provider EMRs, unleashing the power of those EMRs and greatly enhancing their organization’s ETDBW quotient. This application has faced limitations in the past due to traditional EMR integration technologies. Our APIs have removed those limits and opened up new possibilities for agility and innovation of an already great product.

This kind of technical enablement is a huge step forward in making organizations ETDBW and finally cracking the code on a perennial favorite like referral management. They also go a long way to towards extracting value from the large investments made in EMRs over the last decade. Given the stakes when it comes to quality, satisfaction and revenue, it’s about time.

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Dave Levin, MD is the Chief Medical Officer for Sansoro Health where he focuses on bringing true interoperability to healthcare. Dave is a nationally recognized speaker, author and the former CMIO for the Cleveland Clinic. He has served in a variety of leadership and advisory roles for healthcare IT companies, health systems and investors. You can follow him @DaveLevinMD or email Dave.Levin@SansoroHealth.com