Check out a great case study on reducing out of network leakage and improving access to care at a major integrated delivery network. here!
Check out a great case study on reducing out of network leakage and improving access to care at a major integrated delivery network. here!
Here are three tactical ways primary care practices can improve the patient referral processes and see immediate improvements in patient followthrough with referral appointments.
1. Dedicate staff members to actively manage referrals
Designate members of the front desk or administrative team as the practice’s referral coordinators. The referral coordinators orchestrate the referral process and track the progress and outcomes of each patient referral. Referral coordinators should be good communicators who work well with patients and providers, both inside and outside the practice. Referral coordinators should also be highly organized, familiar with the practice’s information systems and time expectations for various referrals, and be willing to take persistent action to facilitate and track referrals.
2. Create scalable, repeatable referral workflows to ensure the referral loop gets closed
To the greatest extent possible, the practice should create standardized referral workflows that are scalable, repeatable, and transparent. Too often, referrals are handled ad hoc by multiple members of the staff, using faxes and phone calls to transit patient information and track referrals. That system is inefficient and opaque—patients are lost and potentially catastrophic outcomes can ensue. Rather, all referrals should be routed through the referral coordinators so that the referrals can be tracked. Ideally, the referral coordinators would utilized an automated, end to end referral management solution like Fibroblast, which guides patient referrals to the most appropriate network provider, ensures the timely two-way flow of information between providers needed to complete the referral process, and tracks referrals in real time. After all, the referral doesn’t actually happen until the patient receives the care or services the patient needs; the referral loop isn’t closed until the referring provider receives information back from the consulting provider about the patient’s care.
3. Engage the patient with referral-related messages
The most important and most overlooked stakeholder in the entire referral process is the patient. The most common reasons why patients do not follow up on referrals for care are confusion by the process and frustration over scheduling an appointment. What is more, recent research indicates that 72% of patients would like to communicate with their medical providers over email and 63% would like to communicate by text message. The practice should adopt an automated patient messaging application, like the one offered by Fibroblast. By sending patients automated, preference-sensitive messages about their referrals, the practice keeps patients informed and engaged, greatly increasing appointment attendance rates and promoting better patient outcomes.
On February 2, 2016, Dr. Andrew Albert, Chief Medical Officer at Fibroblast, Inc., led a webinar to discuss how quality measures can help health systems to improve upon their population health goals for today’s newly-chartered world of shifting payment and care delivery models. The webinar hosted approximately 100 listeners and featured speakers Dr. Nikhil Parikh, an Academic Internist, Mr. Robert Sehring, Central Region CEO of OSF Healthcare, and Dr. William Markey, a solo practitioner in the field of Gastroenterology and Internal Medicine. Providing a holistic discussion of population health, the webinar began with a patient interview and ended with perspectives on the future effects of population health on the healthcare industry at large. What follows are the key take-aways.
The status quo for patient care does not adequately promote effective population health management.
As speaker Dr. Nikhil Parikh noted, the job of a primary care physician (PCP) is extremely challenging. With patient routine appointments increasingly being pushed into 15-minute time blocks, PCPs do not have adequate time to ask every question or suggest every appropriate screening for a particular patient. Compounding the issue, many new patients for a given PCP are missing vital health information in their medical records which would have alerted the PCP to perform certain preventative care measures. These systemic frustrations engender a ripple effect from the PCP, to the patient, and onward to specialists and health system leadership. Take the example of the patient interviewed, Margaret, who was diagnosed with colon cancer at approximately 70 years old. Margaret never visited a GI doctor or underwent a colonoscopy until she presented to her PCP with some alarming symptoms. A colon cancer diagnosis is especially devastating since for many patients, it’s a detectable and preventable disease. What is needed are tools to ensure that patients are receiving their early detection screenings: preventative colonoscopy exams are suggested for patients beginning at the age of 45, a full 25 years sooner. The status quo of ignoring preventative care recommendations and presenting to PCPs only once symptoms arise allows patients to slip through the cracks. (For a more in-depth discussion about patients who have fallen through the cracks in the healthcare system, check out our recent blog post Missed Connections.)
It isn’t just patients who experience the status quo strain. Speaker Dr. William Markey described how specialists are inundated with late-term diagnoses for what could have been preventable cases. From his perspective, population health goals are not forced onto specialists per se; however, discussions around new and improved quality goals are now becoming more routine. As such, specialists and PCPs alike are playing increasingly involved roles in population health management, sometimes without even realizing their uniting objective. For Dr. Markey, patient education is at the root of population health. In his opinion, patients should be exposed to more teaching opportunities surrounding the topic of proper health care and disease prevention. Furthermore, he maintains that such teaching opportunities should occur along patients’ entire care continuums, regardless of the difficulty of finding proper tools to facilitate this knowledge transfer. The third undulation occurs at the administrative level. There is no doubt that setting quality goals to propel successful population health management can be daunting. Moreover, the impact of administrative decisions to align with Medicaid and other government program goals must be careful monitored given its flow down to care management practices.
The transition to new care delivery and payment models, coupled with focused measurement of quality goals, is necessary for the future sustainability of healthcare.
Whether taken from the perspective of the patient, PCP, specialist, or administrator, the healthcare market is changing drastically in the areas of delivery, payment, data privacy and security, technology, and beyond. In taking listeners quickly through highlights of the most important recent changes in the healthcare market, Dr. Albert elucidated that each stakeholder in the healthcare industry can feel the ‘ground shaking’ underneath her. One of the most poignant points was the vast difference in various stakeholder agendas. Commercial payors are drastically compressing provider reimbursement rates and upping the requirements and criteria for reimbursements. Government payors are calling for a complete overhaul of care delivery and payment models. Providers require better tools to manage to their business goals while simultaneously maintaining their provision of excellent clinical care; health system administrators are fighting to maintain sufficient margins to keep their doors open. Furthermore, the requirements associated with the ICD-10 transition and the burgeoning EHR interoperability challenges only stress health systems further. Yet progress is being made on the quest to achieve higher-quality, lower-cost patient care.
Quality measures will focus and drive efforts to achieve population health goals moving forward.
When asked, “Is there anyone who will not be affected [by population health goals]?” Mr. Sehring firmly answered, “No, not if we are going to be successful.” As healthcare delivery transitions from today’s emphasis on ‘sick care’ to high-quality preventative care, one hopes that scenarios like Margaret’s will disappear. Increased focus on population health management and quality metrics will benefit all healthcare industry stakeholders. According to Mr. Robert Sehring, a fee-for-service (FFS) payment system is an example of a “misaligned incentive.” From the payors’ perspective, FFS results in higher costs and not necessarily better patient health outcomes. To facilitate the transition to value-based care delivery and associated payment models and attainment of specific population health goals, Mr. Sehring suggests a team-based approach that includes other ancillary services such as health coaches. The linchpin of effective population health management is the delivery of quality care and the attainment of quality measures. Attainment of quality measure goals serves a dual purpose: support for reimbursements and cost management. Plainly speaking, care of specific patient populations cannot be effective without an astute focus on quality.
Fibroblast, Inc. would like to thank Dr. Nikhil Parikh, Dr. William Markey, and Mr. Robert Sehring for their participation as speakers. Fibroblast would also like to extend its gratitude and best wishes to Margaret and her family.
By Miranda Crowell
If you’re involved in any aspect of a patient referral, patient leakage is a problem which cannot be ignored. Like water dripping from a pipe, patient leakage leads to lost revenue and increased costs. And if money is not enough to perk your ears, patient leakage can also lead to negative clinical outcomes and a poor patient experience.
Patient leakage occurs when a patient’s business leaks out of the system because either (i) the patient failed to make or attend a follow-up/referral visit or (ii) the patient took his or her business to a competitor. While not an exhaustive list, below are four key reasons why patient leakage happens in the first place.
Old Habits Die Hard: Providers and Staff Revert to Past Trends
Like any business, patient referrals can be all about who ya know. When doctors create a relationship and a belief that the other performs satisfactory work, a tendency to refer to that person may form. It can be difficult for new players to enter into this system of trust, even when the new provider is in-network. Without taking advantage of ways to put a medical service in plain sight for other doctors to see, referring doctors and staff may not have knowledge of all the options. Lastly, some staff may have a “We have always done it this way” attitude, but it is this approach that could be costing your business money.
Even if your business has made a strong effort to refer in-network, patient leakage can still occur when the patient subjectively believes that one provider outperforms another. Word of mouth is a powerful tool, so businesses should use this tool to their advantage by capitalizing on in-network referrals when they can and educating patients on the benefits of staying in-network when they cannot. Poor past experiences also motivate a patient to go outside of a network, so businesses should not shy away from the tough conversations.
Sometimes a patient’s lack of follow-up or missed referral has a simple root cause: lack of convenience. A patient may fail to follow-up because (i) the consulting or referred-to doctor took too long to respond to the patient, (ii) the doctor’s office is too far or other access to care issues exist, or (iii) the consulting doctor is not accepting patients (among others). Recently, price has become a part of the convenience discussion. As discussed in a previous blog post, retail healthcare offices are far superior than traditional providers when it comes to price transparency. But even if your office is not ready to post the price for routine services on your website, cost is becoming increasingly important to the consumer. Providing cost transparency for services, such as colonoscopies, mammograms, X-rays, and vaccinations, may poise your business to reduce patient leakage.
A Broken Referral System – Still Largely a Paper-Based System
If the state of the art referral is made on a one-fourth sized sheet of paper or a computer printout, it is no surprise that patient leakage exists. A patient will feel little commitment to follow through with instructions for future action. Conversely, appointments for follow-ups made on-site are an obligation; the appointment is already scheduled into the patient’s life. Moreover, most physicians do not share an IT platform, so there is little way to follow the patient through their course of treatment. This could lead to potential poor outcomes, medical malpractice risks, and poor patient experiences. (You can read more about medical malpractice risks involved in a patient referral here.)
In short, patient leakage is a preventable problem. Unless the rusty pipes are acknowledged, patient leakage could be bleeding your business of downstream revenue. With a few minor changes and some clever tools, such as Fibroblast’s referral platform, the problem of patient leakage can be a problem no more.
By Miranda Crowell
In the health tech world, “interoperability” is a fancy word begging for a hashtag and for acceptance within the medical community. With a continuously growing push for the use of electronic health records (EHRs), the issue of interoperability gained the attention of Energy and Commerce Committee Chairman Fred Upton (R-MI) and Rep. Diana Degette (D-CO). The 21st Century Cures Act (Cures Act) is sprawling, with topics ranging from drug development to clinical trials. And when it comes to interoperability, the Energy and Commerce Committee hopes that the Cures Act, if passed by Congress, might ease the process of sharing research and clinical data by making systems more interoperable.
But what does interoperability mean and why is it important? Depending on who you ask, interoperability has various definitions. In short, it is the ability for one system to connect with another system. The Office of the National Coordinator for Health IT (ONC) defines the term as “the ability of systems to exchange and use electronic health information from other systems without special effort on the part of the user.” The definitional stance taken by ONC and HIMSS, or the Health Information and Management Systems Society, includes various levels of interoperability and stresses the notion that interoperability includes data-sharing between and among various EHR vendors and other health technologies. Moreover, interpretation of data by the receiving system is important, at least to some degree. Consider this banking analogy as an example of an interoperable system: any ATM can facilitate a withdrawal from any bank at any time, and thus, the ATM is interoperable among banking systems.
There is a glaring need for interoperability standards in the healthcare field. For example, a local, independent doctor may have little to no electronic method to share a patient’s health information if that patient visits a hospital. This scenario highlights a common problem where a lack of access to information, or the slow speed of access to information (should such access exist), could lead to a poor patient outcome. To that same point, the Department of Health and Human Services (HHS) states that a lack of immediate access to relevant health information is the cause for 20% of preventable medical errors. These examples and statistics only scratch the surface on the need for interoperable health systems.
Zoning in on interoperability, the expansive Cures bill directs HHS and ONC to set standards for what makes a particular health technology interoperable. In order to be considered interoperable, the technology in question must (i) allow for the secure transfer of the entirety of the patient’s data, (ii) allow access to the entirety of the patient’s data without special effort, and (iii) not be configured to block information. A more detailed description can be found here at page 236, and the specifics surrounding these standards are forthcoming by HHS and ONC. Earlier drafts to the Cures bill did not include any specific language on the topic of interoperability, but the Energy and Commerce Committee responded to pleas from groups such as Premier Inc, a healthcare improvement alliance group.
As sweeping as the Cures bill may seem, there are some issues when it comes to the interoperability sections of the bill. For example, the College for Healthcare Information Management Executives, a professional organization for senior-level healthcare IT professionals, was displeased when the new version of the bill did not include any language on patient identifiers, stating that a standardized approach for collecting and sharing data can only occur when a patient can be positively identified. Moreover, EHR vendors will not be penalized for a lack of interoperability until January 1, 2018. As Fibroblast CEO Scott Vold voiced, “Washington is moving at a glacial pace to increase interoperability; the two and one-half year gap between the present and the implementation of penalties for EHR vendors is too long because the technology could change and the market could shift.” (You can hear Scott’s thoughts on the Cures bill and other topics on here.) The bill received a unanimous 51-0 committee vote on May of 2015. And as the bill makes it way to Congress, all health-tech parties should keep one eye on Cures and the other on the ever-changing world of healthcare technology.
Clinically Integrated But Not Necessarily Aligned: Who’s to blame for patient leakage in Clinically Integrated Networks?
Patients are falling through cracks in our healthcare system, leading to poor patient outcomes and hundreds of millions of dollars in lost revenue opportunities per healthcare system. This problem is intensified by declining fee for service reimbursements and the financial risks of value-base payment models.
Why does out-of-network patient leakage occur, who is to blame, and what can be done about it?
On June 24 at 12 PM CDT, Fibroblast, in collaboration with Matter and EDLoop, is hosting a one hour webinar discussion of how and why out-of-network patient leakage occurs in a Clinically Integrated Network from the perspectives of an independent private practicing physician, an employed physician, and former ACO executive.
Click on the flier below or this link to register.