You might be surprised to know just how many doctors’ offices still use manual processes for referral management — faxes and scans specifically. The fax comprises around 75 percent of all medical communication by one estimate. The “why” is more complicated, but it’s largely about self-preservation.
“It turns out there are strong economic incentives for doctors to keep patient information to themselves — and even stronger incentives for electronic medical records not to play nicely with each other,” as a Vox article explained further. A “walled garden” makes for great patient loyalty within networks. Plus, health care is among the most regulated industries, and there is an often misunderstood HIPAA clause at play here as well, that records are more secure via fax than email (this is categorically untrue by the way).
A looming federal government mandate aims for health care organizations to transition fully from paper to digital records by April 2022, and the government spent over $30 billion on this effort, taking the 9 percent of hospitals who were using electronic records to 83 percent by 2015. What was left unaddressed: information-sharing. So if a clinic has “gone digital,” there is still a high likelihood that their electronic system cannot connect with others’ systems, thus the fax work-around.
Ways to improve your organization’s inefficiencies go beyond killing the fax and should ideally involve some level of workflow “automations” as well. Identify all of the individuals, teams and facilities involved with current workflows, and assess if there any paper, duplicative or manual entry processes that can be revisited.
“This is a massive undertaking, and every health care organization experiences pain around their digital transformation and automation efforts. It’s ultimately about how to choose the right electronic data and integrations vendors for an organization’s specific needs,” said Bridge Connector Chief Revenue Officer Andy Harlen.
The beginning of a health care practice’s patient interactions involves both “preadmissions” and “intake” processes, which means, “Welcome to the world of referral management.”
At a visit with their primary care physician (PCP), it is determined that a patient requires a couple of specialist appointments. Which providers, for financial, expertise, or geographic reasons, get those referrals? How does the PCP learn when the additional appointments are scheduled, if the patient keeps them (around one-third never follow through with these appointments), and how are the resulting treatment plans, lab or test results communicated back with the PCP, the torchbearer most ultimately held accountable for outcomes. This is understanding referral management at the most basic level.
With over 100 million referral visits happening per year in the U.S., “patient referrals” to specialists have emerged as one of the most “fundamental and frequently performed tasks in clinical practice.”
At the highest level, referral management also refers to how health systems can generate more revenue by keeping more referrals within their networks, or preventing “leakage” outside of their systems. Referral management platforms such as CareConnect and dozens more have emerged, as have companies that scrub claims data against referrals, such as Perception Health, so that providers can get the right kinds of patients more quickly.
The problem, however, is that “Referral management requires clinical data to solve a business problem,” as Harlen put it.
“EHRs are great clinical tools. But referrals, at their core, are a business problem, not a clinical problem,” said Harlen. “How do you close gaps within the continuity of care? And how do you better equip businesses to prevent referral leakage outside of their networks?”
In addition to separate referral management platforms, you are still dealing with multiple disconnected other platforms, such as scheduling and billing. But “there is absolutely technology in place to connect these platforms, automate workflows, and make major improvements,” he said.
Harlen is referring to the growing trend of employing a Customer Relationship Management (CRM) platform, such as Salesforce, as the singular “source of truth” for all patient information. And data integrations supply the missing links between the various platforms, to and from the CRM. We’ve discussed the themes that support referral management in a recent blog about post-acute care (PAC) settings. But that doesn’t mean that problems around referral management are limited to these settings, or that organizations don’t have unique needs. With around a decade of experience delivering SaaS and integrations solutions in mostly PAC settings, which have grown significantly in recent years, Harlen stresses that referral management can mean different things to different organizations, based on where they are experiencing organizational and administrative pain points.
“The question I would first pose to health care organizations who are seeking to improve referral management and vetting vendors, is, ‘What are your pain points?’ and work your way down from there,” said Harlen. “What workflows are touching it, and what can automations bring to the table?
An organization cannot arrive at solutions if they first don’t define the problem, in very specific terms and via gap analysis. This may require a great deal more communication and problem-solving back and forth than was originally anticipated, between the organization and their trusted team of vendors, to ensure the successful implementation of solutions. A vendor search should therefore be more about seeking a “partner” that can meet you where you are, but also be forward-thinking and transparent around associated maintenance costs. Because there are always upgrades that will continue throughout the life of any digital product or platform. “The first thing I hear during a call that I know we can make better is around duplicate or manual entry. This literally loses providers time with every single patient,” said Harlen. “But these same providers are also not able to choose which patients are best from an insurance perspective, or from the scope or severity of the patient’s ailment, simply because the industry has been living with disconnected systems and these sorts of inefficiencies as the ‘status quo.’” Improving referral management is therefore an easy way to understand the value that data integrations can offer in that they improve both the patient’s experience as well as the health system’s ability to make business decisions. Integrating siloed platforms can even put marketing and intake data on the same system at the same time, so providers can better market to their referral sources. But perhaps most importantly, from a revenue perspective, referral management integrations allow you to understand where the competition is beating you, as well as how to improve patient loyalty.
“There is a better way to do referral management,” said Harlen, “and when you get the right patients in and fill in the informational gaps, this not only has tremendous revenue-generating power for our clients, but it allows providers to provide better care for patients — the brass ring everyone in health care is ultimately striving to reach.”