4 Care Coordination Strategies to Drive Change

Guest post by Andy Ridinger, director of client experience, MyHealthDirect.

Andrew Ridinger
Andrew Ridinger

Despite much of the uncertainty facing the future of the health care industry, the shift to value-based care is not going to go away. Regardless of what new laws may decide, organizations need care coordination tools now more than ever to be successful. Doctors and hospital officials continue to cite care coordination as a key advantage in accountable care models, which seek to more tightly integrate providers and maintain joint financial incentives that deliver better-quality and lower-cost services.

In the United States, more than a third of patients are referred to a specialist each year, and specialist visits constitute more than half of outpatient visits. Referrals are the crucial link between primary and specialty care. Yet despite this frequency, the referral process itself has been a great frustration for many years. The transformation to value-based healthcare is well underway with a shift away from the quantity of patients to the achievement of better health outcomes.

The current state of the specialty-referral process in the U.S. provides substantial opportunities for improvement, as there are breakdowns and inefficiencies throughout. These are inevitable when the process hinges on a patient following through on a slip of paper. It is no wonder that of the one third of patients that receive referrals, 20 percent never follow through to schedule a visit. Of the referrals that are completed, a host of other challenges often result. Sometimes it is just a disconnect of information between the two providers but can be an incorrect provider altogether. The final outcome is poor for everyone involved; patient, referrer, and target provider alike.

To improve the referral process and care coordination, here are four strategies to facilitate greater convenience in care coordination initiatives:

Make it digital 
Just by enabling online booking, referral lead times (time between a PCP and specialist office visit) decrease by up to 36 percent, and show rates improve by 20 percent. Additionally, on the spot booking to a specialist reduces patient leakage for health systems. It can guarantee that care is rendered by the best-suited physicians within your preferred network.

Make it best-fit 
The most effective appointment maximizes show rates and minimizes lead times. A provider must select the preferred physician with the earliest availability at a time the patient is likely to show up. Optimized scheduling can yield up to a five times increase in referral completion rates.

Make it measurable 
The best way to improve referral completion rates and reduce lead times is to capture the relevant data points in a timely manner so that you can track changes over time. Presenting the data in an easily consumable and actionable format is equally critical.

Connect the docs 
To know if patients complete visits, it is critical that all parties share the right information and facilitate two-way communication in real time. A primary care physician making a referral is far better equipped to manage a patient’s health if she receives show status and notes back from the specialist visit as soon as that information is entered into the specialist’s electronic health record.

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Referral Management: Why It’s More Critical than Ever

Guest post by Adam Sharp, MD, CMO par8o.

Adam Sharp, MD
Adam Sharp, MD

There is an industry-wide surge in providers, payers and post-acute care providers whose needs for transitions-in-care are unmet by their current healthcare IT capabilities. As such, 2016 will likely be the year that referral management comes to the forefront for all stakeholders in the healthcare system.

The moment of referral is an opportune time to engage with patients: with the increase in high-deductible plans and out-of-pocket expenses, patients are extremely motivated to seek care from high-quality, cost-effective, in-network providers. Providing patients with the resources they need, while enabling providers to align their efforts, is a mission-critical need in healthcare today.

There are a few key factors driving improvements in referral management for providers, payers, and post-acute care providers alike:

For providers

With the move to fee-for-value reimbursement, we are seeing a rise in the number of physicians moving to independent physician associations, ACOs, and clinically integrated networks.  This is happening for two reasons: first, to negotiate more effectively with payers and second, to equip themselves to take on risk in the future.  In order to take on risk effectively, healthcare organizations will need to ensure that patients stay within their systems.  In addition, these groups of physicians often have multiple EMRs and are looking for solutions to expand them.  Therefore, we have seen an increase in all kinds of provider groups looking for intelligent decision support that guide referrals in a systematic and strategic fashion.

For payers

With the increase in high deductible, narrow network plans, there is a greater need to direct patients to high-quality, low-cost providers.  Payers, in partnership with providers, are looking for the ability to navigate patients in this way. Given the cost of specialist visits, payers are also particularly interested in making sure patients get to the most appropriate specialist to receive the care they need.

For example, Carefirst BCBS has pioneered a program, through their PCMH plan, to provide information on specialist costs and quality to inform referrals.  They see this as a way to improve quality while, over time, bending the cost curve.  This could be the beginning of a broader trend among payers, to acknowledge the importance of referrals and encourage the use of tools designed to implement insightful decision support and a standardized process around transitions-of-care.

For post-acute care providers

As providers have consolidated, so has the post-acute care space.  Readmission penalties and bundled payments have further put pressure on post-acute care to ensure a seamless transition from acute care to – and within – different post-acute services.

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