Building the Right Strategies for Improving Referral Network: What Leaders Need to Know?

Lack of defined communication channels has been a long-standing challenge for our healthcare system. Most organizations operate in silos which often limits their operational efficiency. From scheduling patient appointments to checking on their health condition, the US healthcare system needs a serious presto chango at multiple fronts.

Referrals have been one such area of concern that has long been overlooked. Physician referrals are, in a way, one of the most significant forms of primary-specialty care communication. On a financial front, they can be considered a major source of specialty care patient influx.

Healthcare organizations, therefore, need to come up with the right roadmap to improve the overall quality and hospital traffic. Most organizations need to work on one or more areas listed below to build a comprehensive referral network.

1. Consolidation of network— Improve the network knowledge within network

Building a tightly knit system of physicians and other care team members can be the first step towards solidifying a referral network. Often patients & physicians choose specialists/consultants with limited knowledge of the available options. Access to such information on the network’s physicians is directly relevant to the impact on the effectiveness of the referral process. There is a need to have an enhanced process of selecting consultants while sending managing referrals. For this, it is imperative that the organization has made sure that its participating members know each other.

Information within referrals should be embedded within an EMR so that there is a potential to improve the timeliness and quality of referral communication and may also improve patients’ referral experiences. This will ensure that physicians have all the information about the other in-network physicians and they are sending the patient to someone with a data-backed decision.

2. Ensure that contextual patient information is available to the physicians while sending referrals— Including lifestyle

While a physician’s call for referring a patient is generally based on their reading and lab tests, access to critical patient information can play a huge role in enabling timely referrals. Physicians should also consider lifestyle habits and living conditions while making referrals, since these factors hugely affect the health of people. For instance, a patient with a history of heart attacks needs to maintain blood cholesterol at an optimum level, and his/her PCP needs to know this. Likewise, a regular smoker with blood pressure readings higher than, say, 120/80 millimeters of Mercury is at risk of possible stroke, and his PCP need to regularly keep a tab on him/her.

According to a study, about 20 million referrals are made to ‘clinically inappropriate’ providers annually, majorly due to the lack of contextual information. Physicians, therefore, need to know the minutest of health issues, utilization patterns, and treatment procedures. Patients also have personal goals of maintaining a certain health standard, e.g., lose weight, reduce cholesterol, etc.

Source: Diederich Healthcare

3. Analyze volume, trend, and outcomes of referrals and then optimize them

Every leader needs to know which provider refers how often, to whom, and when. They also need to know how justified each referral was in terms of care needed and total cost borne by the organization.

In some cases, physicians refer patients based on their personal relations, trust, or location. An altogether different situation arises when a physician doesn’t make in-network referrals and send patients outside their network. While such cases are slowly declining, they are far from being eliminated. Additionally, nurses and care coordinators play a significant role in determining the referral patterns since they tend to spend more time with patients than anyone else.

Organizations are focusing on building a network based on evidence and growing outpatient revenue based on referrals and orders from independent providers. According to a survey, 57 percent of respondents are using this strategy to drive revenue growth.

4. Physicians should be able to communicate with peers and extended care teams

Communication contains a substantial proportion of the health system information ‘pathology’, but is usually ignored in our thinking. Even a small care team has the capability of creating a complicated network. If multiple physicians involved in a patient’s care continuum can communicate with each other regularly, the quality of care naturally improves drastically.

Many referring physicians never find out whether the patient actually met the specialist or not. Therefore, a referring physician should be aware whether the specialist is accepting referrals, or if he has time, or would the specialist be able to respond quickly to the request of referral. If a patient is treated by two different physicians for two different conditions, both the physicians should follow-up on the other. Suppose, physician A had recommended aspirin while physician B has prescribed coumadin, and both of them are not aware of each others’ involvement, a possibility of drug interactions can cause problems for the patient.

Healthcare leaders need to channelize their efforts towards making communication gateways simpler and more comprehensive for their providers. Creating an environment for seamless, real-time, and remote communication is the building block for making effortless referrals a reality.

5. Educating patients about their role in their health is critical and it drives shared decision making

Patients can no longer be perceived as passive respondents of the care delivery system. Today, they are empowered ‘customers’ who have a say in matters related to their health, and rightly so. Leaders should look towards further strengthening them by spreading more awareness and initializing concrete physician-patient engagement strategies.

Patient education becomes necessary to transform patients into agents of self-care. As patients begin to take an active role in their own health, it makes the care delivery process incredibly effective and efficient. Therefore, educating patients is as important for the provider community as it is for patients.

At the end of the day one needs to know:

• Does my patient know how to manage chronic illness?
• Does my patient know how to live healthier?
• Does my patient know where to get help when needed?
• Does my patient know how to take care of themselves at home?

Nothing ventured, nothing gained

According to a research finding, referral leakages cost over $90M in revenue loss for every 100 employed physicians for a healthcare organization. It is important to understand why patients leave the network, and why providers sometimes fail to score on opportunities. There is no time like the present to move away from leaving millions on the table and risking patients’ health owing to ineffective referral cycles. The old methods might be of little use today, and leaders should follow a more innovative approach for building a sustainable referral culture, and further leverage the right technologies to assist their care teams wherever possible.

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This blog has originally been authored by Abhinav Shashank.