Check out our latest case study on Provider Network Analytics by clicking here!
Check out our latest case study on Provider Network Analytics by clicking here!
Referral management and network leakage reduction were already top-of-mind issues for providers, and thanks to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), they will now be even more critical.
MACRA introduces new formulas to determine physicians’ Medicare Part B payments based on how they perform relative to other providers. Implementation of these performance-based payments will be phased in over the next few years, beginning with data collection in 2017 and at-risk payments in 2019. Referral management will play a key role in determining providers’ success under MACRA, influencing their performance on numerous measures. In addition, several of the new measures for determining physician payments will specifically track how providers manage referrals.
Medicare Accountable Care Organizations are in full swing and healthcare systems are starting to fully grasp what it takes to manage them.
A recently published article in JAMA Internal Medicine explored the largest and most pressing problem with Medicare ACOs: managing the member population. The authors explored the stability of the member populations, network leakage, and proportion of care provided to ACO beneficiaries relative to other patients.
The results from the JAMA research were unsurprising. Medicare ACO populations are extremely unstable, with one in three patients moving in or out of the ACO year-to-year. Leakage to other networks is also extraordinarily high, with 67% of specialty visits occurring outside of the ACO network. Lastly, the amount of care devoted to ACO beneficiaries is only about 38% of the total care provided at a system. These are not the results anyone wants to see – neither Medicare nor providers.
FIBROBLAST AND OPTUM ANNOUNCE PARTNERSHIP
Companies form strategic alliance to deliver cutting-edge referral management solutions to healthcare organizations
CHICAGO, IL & EDEN PRAIRIE, MN – Fibroblast and Optum have announced a strategic partnership to bring Fibroblast’s referral management platform to Optum’s suite of comprehensive healthcare solutions. Fibroblast will serve as Optum’s referral management solution under the partnership, available to all new and existing Optum clients. Fibroblast strategically integrates with Optum’s technology and services to provide enhanced value for value-based care, care coordination, and analytics capabilities.
Optum chose Fibroblast after a competitive evaluation of referral management products available to the market. Optum will offer Fibroblast’s full suite of referral decision support algorithms, referral workflow, and analytics tools as solutions. Fibroblast will continue to independently serve its existing clients, while bringing on additional business through Optum and other channels.
Said Scott Vold, Fibroblast CEO and co-founder: “We are thrilled that Optum has chosen our referral management solution. Optum serves some of the most forward-thinking healthcare organizations today. We believe our propriety referral matching technology and workflow management tools present immediate value to those systems seeking reduced network leakage and better coordination of care.”
Fibroblast will be immediately available to all existing Optum clients seeking referral management solutions. Prospective client organizations can contact Optum or Fibroblast to request more information or to see a live demonstration of Optum and Fibroblast’s solutions.
Fibroblast is a leading provider of referral decision support, management workflow tools, and analytics. Its solutions reduce out of network patient leakage, close gaps in care, and provide real-time referral analytics. Fibroblast’s referral management tool algorithmically guides referrals to the highest value, most appropriate providers, capturing incremental revenue, reducing risk, and eliminating administrative expense. For more information, visit www.fibroblast.com.
Optum is a leading information and technology-enabled health services business dedicated to helping make the health system work better for everyone. Optum delivers intelligent, integrated solutions to modernize the health system and improve overall population health. For more information, visit www.optum.com.
Patients are not getting the care they need, yet employed providers are not at capacity. Health care systems are taking on more and more risk, with little accountable care experience and scant tools to manage risk. How can we satisfy the needs of all parties involved? This one-hour webinar will address the importance of population health as managing risk becomes a more practical reality. Learn how you can mitigate risk through better population health management and health outcomes.
Hear the approaches suggested by a colon cancer patient, primary care physician, gastroenterologist, and a regional health system CEO.
By Miranda Crowell
While social media may have all but erased the missed connections portion of the newspaper, the idea still exists. Two people meet and are unfortunately unable to communicate potentially useful information to each other. Healthcare providers are far too familiar with missed connections. But this isn’t the sappy kind you see in the movies. It’s the worst type of missed connection – the kind where despite each party involved doing his or her job diligently and correctly, a bad experience and a negative health outcome for the patient still ruin the climax of the story.
This is precisely the type of missed connection recently experienced by one gastroenterologist, Dr. Raye (as we will call him). Dr. Raye met with a 70-year-old patient with normal mental status named Ellen (as we will call her) and delivered to her a diagnosis of cancer. After some brief in-office education, Ellen was sent home with explicit directions to obtain follow-up tests and receive further care from several recommended specialists. Time passed. But when Ellen returned for her next appointment with Dr. Raye, Ellen was completely stunned by Dr. Raye’s request as to the whereabouts of her lab results. It was as if she hadn’t been present for the initial diagnosis and the discussion of plans for her future treatment and care. . .
This type of missed connection is not only predictable; it’s preventable. This isn’t a personal failure on the part of the doctor, the patient, or her family. It’s a systemic problem. While the industry may be loosening its reliance on old payment models in order to take advantage of the much-anticipated benefits promulgated under the Affordable Care Act, a fee-for-value system does not do enough to unbreak the patient referral process. A scribbled prescription pad or a computer printout instructing a patient to receive further care depends on the patient to proactively and diligently follow up for his or her treatment and care to proceed as was prescribed. This heavy reliance on patient self-management, however, allows some patients to all too easily fall through the cracks of the healthcare system.
There is however a solution to this problem and tools to help. Electronic referral systems are one such tool. They come with many benefits including analytic capabilities and perhaps most importantly an opening of the line of communication among providers, care coordinators, and patients, thus connecting the dots in patients’ care. An open line of communication and closed information sharing loop among Ellen, Dr. Raye, and her oncology specialists could have led to a better experience and improved health outcome for Ellen. Fibroblast is a referral management tool committed to promoting better patient outcomes, improving patient health, and ensuring that patients like Ellen never fall through the cracks of the healthcare system.
These five Chicago tech companies are shaking up and disturbing the success of some industries.
Health care systems are becoming more involving in the achievement of population health measures. How can they achieve this goal with a fragmented system of disparate provider goals and conflicting agendas? This one hour webinar will address the importance of a strong physician network as the backbone of your institution, and the key to achieving your population health goals now and in the future from the perspective of a medical director, a private practice physician and former ACO executive.
Time: 12:00 PM Central
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.