Healthcare providers and administrators are under increasing pressure to take a scientific approach to running their organizations. Competitive and regulatory pressures are constantly increasing and the burden of risk is quickly shifting to those who provide care. Physicians practice evidence-based medicine to achieve the best outcomes for their patients. Shouldn’t our administrators use evidence-based decision-making to steer and strengthen our healthcare organizations?
To help with the momentous transition toward value-based care, clinicians and administrators are armed with more technology and reporting tools than ever before. The proliferation of electronic medical records, decision support systems, and the digitization of medical information represents one small step for patients and one giant leap for medicine. Enterprise resource planning systems have added sophistication at the provider level. But what about the network level?
For clinically integrated networks (CINs), network-level data and reporting is crucial to patient outcomes, population management, and financial success. Yet all too often, health systems are forced to sift through stale or inaccurate claims data from separate systems across a network. Worse still, the cycle of claims data can vary substantially by physician, location, specialty, and payer. Decision makers are left in the lurch without the ability to quickly make actionable changes.
Referral management is a critical process in today’s modern health systems. Retrospective claims analysis, however, leaves administrators inferring trends from data, guessing at leakage rates, and drawing incomplete and incorrect conclusions about their practitioners. Often times, referral data is not captured in any system of record at all. Staff members are left with their hands tied, unable act without the right information.
Accessing referral data at the physician and individual referral level is the key to success, and only a tool that actively manages the referral workflow can provide this level of insight. In contrast to market analytics platforms, referral workflow tools manage and track the referral process in real-time across an entire network, capturing and storing valuable information at each step. They allow providers and staff to quickly analyze referral trends, network leakage, physician volumes, and other key performance indicators using up-to-the-minute, on-demand reporting. These insights can include referral data not captured in claims, like patient no-shows, provider response times, and scheduling information.
With referral workflow tools, staff members have a wealth of information, down to the individual practices, specialties, and physicians. Administrators can perform root cause analysis and make actionable recommendations, in real-time, to improve their organizations. CINs can take advantage of the scale of an integrated tool across hundreds or even thousands of providers. Patients reap the benefits of coordinated care and a seamless patient experience.
In an increasingly complex and risk-based environment, referral management tools provide a valuable workflow solution that standardizes processes and improves the patient experience. Equally as important, however, they give administrators the power to practice evidence-based management to stay competitive in the marketplace and strengthen their organizations.