By Matt Wilson

After seeing their primary care physician, a patient may need to be referred to another physician or surgeon for additional care. But what if the patient were invited to see how a traditional referral process works? Most would be taken aback at how unsophisticated the healthcare system can appear.

Example: a patient is handed a slip of paper with a specialist’s name and phone number, the PCP’s office staff waving goodbye and wishing them luck as they exit. Should the patient fail to schedule the referral on their own — something that is all too common — there is a decent chance there will be no follow-up from either physicians’ office. The result: a patient goes without proper, possibly vital, care. They “slip through the cracks” and become another leakage statistic.

For fortunate patients, the referring provider’s care coordinator may work with the patient and the specialist’s office to help book a convenient time and ensure that their insurance plan will cover the visit. They may even send over any vital documentation. In 2018, too many healthcare providers do not leverage technology to manage their referral networks, resorting to paper-based, labor intensive workflows at a time when they are held more accountable than ever before for the care they provide.

Assessing referral networks

Though referral processes will vary from provider to provider, how they decide where to refer each patient does not. More than likely, providers are going to refer their patients to the same specialists and groups that they have been using for years, possibly decades. The decision to refer to these specialists is unlikely to be the result of an objective, in-depth cost and quality analysis. So, what are possible reasons they start referring to them in the first place? Their colleagues made a recommendation; they went to the same medical school; or they met at the tennis club.

Any way you look at it, it is fair to conclude that most providers are not efficiently managing their referral networks. What isn’t fair is the result this can have on patients due to the resulting quality and cost of care. Before we cast too many stones, it is important to note that providers have not had access to tools needed to optimize referral networks and guide patients to the most appropriate specialists. They’ve simply trusted their gut, made a decision and fell into a routine. After all, doctors are people, too.

Fortunately, companies like Fibroblast help providers build and manage high performance referral networks, utilizing rule-based workflows to increase revenue, reduce value-based risk and improve patient outcomes. Technology now exists to guide each patient to the single most appropriate specialist for them. It is individualized population health management, an industry development that is sure to impact the cost and quality of care.

Fibroblast’s proprietary algorithm takes into consideration top variables that should be reviewed for each patient’s referral: network affiliation, quality, cost, accepted insurance, responsiveness, availability, tests and procedures performed, distance from the patient’s home, etc. When providers come face-to-face with this data they more often than not start to change their referral patterns. They can be confident they are selecting a specialist that is most likely to deliver the most optimal outcome.  

Infusing referral data

Objective and relevant referral data can influence provider choices at the point-of-care. When a provider knows their patient requires additional care beyond their scope, they want to set a referral in motion and move on. If a provider wants to ensure that each patient goes to an in-network specialist that participates with the patient’s health insurance plan, but they don’t always have the data they need, then Fibroblast is a logical solution.

Fibroblast has the ability to show red flags, like unacceptably long wait times for a specialist or low-quality scores. Providers and staff can quickly act on that information and select another specialist. It is, of course, unsurprising that correct information at the right time impacts care. What is surprising is how often necessary, relevant information and data is never considered when making a referral. The healthcare industry still lives in the age of paper-based workflows, and companies like Fibroblast offer a solution that providers need.

Actionable referral data

When supplied with the right information, administrators and providers have the ability to influence referral patterns outside of the point-of-care. They can see — by using solutions such as Fibroblast — what is actually happening in their referral network, where opportunities can be won and where weaknesses can be strengthened.

Executive dashboards allow real-time access, so providers can be assured they are building, growing and maintaining the most efficient referral network; consistently delivering the clinical and financial outcomes that providers want and patients need.

At first glance, referral management seems quite straightforward. In reality, it is an incredibly complex web of interconnected decisions and outcomes. The good news for patients is that providers now have access to technology solutions like Fibroblast to arm themselves with actionable information to help solve referral management issues, which in turn provides each patient with the best possible care.