The Treatspace Referral Management Blog

A critical, but often-overlooked, aspect of the referral process is cultivating provider partnerships that facilitate referrals and enhance the continuum of care. The continued emphasis on value-based care will result in increasing numbers of physicians working together to coordinate care, especially for patients with chronic conditions. While the traditional referral system is generally regarded as inadequate, best practices can help you optimize working relationships with collaborating physicians.

Effective communication is at the heart of success or failure in patient care. This is never more evident than in the relationship between Primary Care Physicians (PCPs) and the Specialists they refer their patients to for follow up examination. The best PCPs provide their patients with an ongoing relationship - they serve as a mentor or partner in health, helping patients understand their specific needs and making recommendations when appropriate. The benefit for patients in developing long-term relationships with their PCP is that they have a trusted physician who knows their history and can more easily assess warning symptoms for new ailments and lifestyle changes appropriate for health risks.

Over the past decade, as healthcare organizations began to implement electronic referral management applications, studies were conducted to measure their overall functionality and value in patient care and satisfaction. The results proved that when handled properly, electronic referral management cured several problems inherent in the old paper-based coordination of care procedures. What emerged from years of trial and error was a clear set of best practices for both primary and specialty care facilities that keeps the patient front and center.

When a healthcare organization decides to implement an ERM, what are those best practices to keep in mind?

Today's healthcare model requires that services be patient-centered. Additional challenges arise, though, when care needs to be coordinated among multiple providers. From 1999-2009, the number of primary care visits resulting in a referral increased by 159%. Research strongly indicates that referring physicians need to improve the quality of information they provide to consulting physicians. When surveyed, 63% of PCPs and 35% of specialists report dissatisfaction with the current referral process. Paper referrals often do not provide adequate information. In other cases, consult reports are not delivered in a timely manner. Many referrals do not even include transmission of information, either to or from specialists.

Relationships between PCPs and specialists are sacred. On average, a single PCP is connected to 68 specialists. However, lack of electronic connectivity makes it difficult to coordinate care and manage referrals—apart from hiring additional administrative staff.

Without patient referrals from PCP to specialist, it is estimated that only half as many patients would show up to their specialty care appointment¹. Furthermore, “self-referral” patients who see specialists without recommendation from a PCP are associated with higher patient dissatisfaction and poorer continuity of care with the primary care doctor². As PCPs refer more patients to specialists each year, coordinated care and automated referral workflow become an urgent issue for both independent and hospital-based practices.

With coordination of care a major aspect of healthcare delivery, mistakes in the process lead to patient dissatisfaction or possibly worse. An excess of frustration in a patient's experience often leads them to pursue other primary care options. Fortunately, the emergence of electronic referral management technology can reduce errors significantly when referring to network specialists. The advantages of an electronic referral network can be seen and measured within those HCOs that adopted them early. As medical enterprises continue to implement the systems, better care coordination and happier patients will be the result.

As value-based care takes center stage in healthcare, primary care providers (PCPs) and specialists must find ways to eliminate communication deficiencies and share information more effectively to ensure a more well-rounded and positive patient experience. Strong quality scores, efficient operations, and credible customer service are no longer just admirable traits of a positive care coordination environment; they’re quickly becoming characteristics that define whether primary care succeeds or falls short in value-based care.

Care coordination missteps are damaging to providers across the healthcare industry and one huge, overarching mistake is apparent: not enough information is being shared. A study by Health Affairs shows that only 14% of physicians share information with providers outside of their organization.

Unfortunately, care coordination mistakes can be costly...and not just in terms of financial expenses. Some of the most common care coordination mistakes are also major culprits for death and exacerbated patient health problems. U.S. News & World Report indicates, “Medical errors are [the] third leading cause of death in the U.S. 10 percent of U.S. deaths are due to preventable medical mistakes.”

We’ve identified six areas of care coordination where many practices make mistakes -- check out what they are, and see how many apply to you.

An alarming number of primary care practices don’t have the staff required to proactively manage referrals. Medical assistant teams lack the capacity required to manage chronic care and quality programs, meet payor requirements, and hunt consult reports from specialists. As a result, these practices manually track referrals only when they are required to for regulatory requirements or internal referral initiatives.

The primary care practices that are proactively managing referrals are doing so with an overwhelming amount of expensive and manual workflow. Care coordinators are adding hundreds of hours to their workflow each month to ensure that patients are completing their appointment and that specialists are returning the clinical information needed for appropriate follow up.

In contrast, primary care practices that automate their referral workflow electronically are recovering up to 70% of their staff’s time [1] spent manually managing referrals.

Improved referral processes help practices meet value-based initiatives and devote time to programs that drive revenue—like preventative and chronic care management.

Healthcare reform is very real. Only primary care practices who prepare now will be ready for big changes in reimbursement and quality metrics. According to Dr. Danyal Ibrahim, the Chief Data Analytics officer at Saint Francis Care in Connecticut, identifying gaps and bringing data together is crucial to overcoming isolated silos in healthcare and to delivering the kind of outcomes that meet and exceed performance metrics.

Providers who don’t harness data for the new era of healthcare “have at least a vague, nagging feeling that they should probably start developing the data-driven competencies.” In a recent HealthITAnalytics article, Dr. Ibrahim described identifying and overcoming data silos as the biggest hurdle of creating a streamlined data analytics infrastructure. “[T]here are so many times when our data ends up siloed, and pieces of information end up going to all different places that cannot communicate with one another...So one big component goes to the finance department, and other to IT, and another to the quality improvement team.”

Forbes magazine weighs in on poor data sharing as “a medical tragedy of underappreciated dimension. Valuable, even vital information often remains uncaptured, unanalyzed, and, especially, unshared.”

Overcoming health data silos is proven to lead to cost savings. A McKinsey Global report estimated that the efficient use of data in healthcare could create more than $300 billion in value every year and quintuple hospital profits.