Hospitals and Health Networks Magazine recently championed the concept of primary care physicians and specialists working closely together as partners, rather than continuing disconnected referral relationships.
Partnering with Primary Care
H&HN’s article touts the increased efficiency and improved patient care in organizations with tightly aligned specialty and primary care partners.
The article says that value-based healthcare organizations “reward comprehensive and accessible primary care services, tight coordination of referrals to specialists and measurement of performance - costs, outcomes, patient experiences, errors.” They “force specialists to interact with primary care providers as partners, not referral sources.”
Partnering is a big change
Instead of referring patients to a specialist and not knowing what happens afterwards, value-based healthcare models create incentives for clinicians to collaborate with each other.
“It forces handoffs across practices, facilities and organizations to be seamless and connected.”
This is a big change that involves altering 30 or 40 years of past behavior, so it doesn’t happen overnight.
As an example, Memorial Hermann Accountable Care Organization in Houston received $23 million in shared savings bonuses, the largest reimbursement thus far. But Memorial Hermann started working on improving care coordination 10 years ago.
“Christopher Lloyd, the CEO of Memorial Hermann’s ACO, credited its success to a decade’s worth of changes that improved cooperation among physicians and the hospital, as well as the creation of systems to share medical details of patients.”
Memorial Hermann’s information systems enable advanced PCPs to share patient information to better coordinate patient care. They also “reduce the chance of medical errors and redundant testing, thus lowering the cost of healthcare.” When physicians cooperate and medical details of patients are shared across systems, patients get better care and physician practices receive better cost and quality scores to boost their value-based reimbursements.
Electronic referral management is an easy-to-implement IT solution
Improved patient handoffs take more than establishing a network of preferred referral partners. Hospitals and Health Networks suggests that better handoffs “require investments in technologies and digital health,” but that implementing IT systems and streamlined process improvements are difficult to accomplish.
However, managing “tight coordination of referrals to specialists” and measuring specialist performance is not far from reach. Innovative primary care practices are adopting electronic referral management applications, regardless of their EHR system.
E-referral systems improve quality, safety, and efficiency of care team collaboration. As a result, PCPs get “enhanced ability to track referrals, decreased wait times for face-to-face specialty clinic visits, and electronic referral programs’ ability to improve patient access to specialty expertise .”
High-performance e-referral systems also provide useful specialist performance metrics that allow primary care practices to refer their patients to their best performing specialists. “Ultimately, it comes down to performance — timely appointments, appropriate communication and top-level services."
Partnerships between PCP and specialist offices are becoming more and more important - in patient-centered medical home (PCMH) models, ACO models and other alternative payment models. These partnerships will gain further popularity as MACRA regulations and other initiatives reward better care coordination.
The days of specialists being viewed simply as referral sources, and not partners, will soon be demoted to the dustbin of history. Electronic referral management will lead the way.
 Healthcare | http://www.sciencedirect.com/science/article/pii/S2213076415000251