Network leakage or patient referral leakage can be a huge challenge to provider organizations, especially for those moving quickly into population health management.
In simple words, network leakage occurs when a patient receives care from a facility/provider that is not part of the hospital’s network. This may cause loss of updates and information relevant to the patient that can result in a tremendous impact on the continuity of care management. Network leakages lead to dire issues, including reduced coordination of care, loss of revenue, and poor patient experience. The root cause of all leakages are referrals made between primary care physicians and specialists.
“Referrals to specialists or other services are about as common in a physician's day as writing prescriptions.”
Why are referral management systems important?
Referrals are a critical moment in a patient’s journey and come with significant implications in value-based reimbursements. However, some healthcare organizations are still operating in silos, which often limits their efficiency. While all healthcare organizations focus on delivering high-quality care, relatively few are able to deliver excellence in referral management. Referrals today are not automated nor data-driven. From scheduling patient appointments to reporting on patients’ health conditions, the U.S. healthcare system needs improvements on multiple fronts. A referral management system powered by a data activation platform simplifies the process and analytics relevant to referrals across the care continuum.
Innovaccer’s referral management system on a FHIR-enabled Data Activation Platform ensures the continuity in care for patients by easily scheduling the right referrals.
What are the reasons for referral leakage?
When a patient seeks care outside their primary care provider’s network, it can result in poor care coordination, reduced patient satisfaction levels, and loss in revenue. Although when certain treatments are unavailable in the network, patient leakage may be unavoidable. However, there are some typical reasons for network leakage:
Providers who have recently joined a health system do not know about the specialists in their network. Additionally, providers may refer to providers in outside networks because of personal relationships, which is in fact a significant factor behind patient leakage.
Messy and incomplete workflows
Research has demonstrated that 25% - 50% of referring providers do not know if their patients completed the referral. Each step happens in a silo across disparate systems. Providers often face challenges in following up with patients or have poor visibility across the entire process.
A challenging system to navigate
Due to gaps in communication, some patients are left to select a specialist on their own, to make sure records are exchanged and actually schedule the referral appointment. Patients may spend hours coordinating all of these activities which are inconvenient and sometimes overwhelming for them.
Limited communication among providers
Both the referring and receiving providers face complications in communicating with each other. Studies show that around 50% of providers do not have contact with one another.
Effectively engage and communicate with your patients with the best in class tools powered by Innovaccer’s FHIR-enabled Data Activation Platform.
How does a FHIR-enabled Data Activation Platform improve referral management?
In order to eliminate the complications mentioned, Innovaccer’s referral management solution allows users to view and schedule referrals at the point of care, and frees them from time-consuming tasks, allowing them to focus entirely on patient-centered care. The tool works on the FHIR-enabled Data Activation Platform and helps providers to initiate referrals at the point of care. It surfaces the right insights about the patient and enables providers to deliver the best care without leaving the EHR experience or facing any other hassle. With the right insights at the right time into the patients and specialists, providers can avoid network leakages and better manage the care continuum. Here’s how the data activation platform does that:
Hassle-free referral generation
The solution surfaces the point-of-care insights about the patient and enables providers to conduct the best referrals. It ensures easy, hassle-free patient referrals in and out of the network.
Customizable network leakage dashboards
With the solution’s strong analytics, providers can keep track of every referral with customizable dashboards and identify out-of-network referrals with just a single click.
Appointment and medication adherence in real-time
The solution enables the providers to track and analyze patients’ adherence to referred appointments and their prescribed medication within the EHR. The solution’s strong algorithm prevents the chances of double documentation thus, eliminating the chances of any discrepancy.
Automated e-fax and prior authorization capability
The solution eliminates the necessity to manually send referral documents to the referred provider. With its e-fax capability, providers can exchange relevant data with prior authorization to the referred provider in just a single click.
Specialist ranking with a holistic physician scorecard
With Innovaccer’s Referral Management solution, providers can access physicians’ specialty and filter them out based on their expertise area, geography and payer affiliations, all visible in the form of scorecards.
With the solution, providers can also easily communicate with patients by sending them automated appointment reminders and updates. The solution creates a two-way communication channel with patients and ensures the deployment of a closed automated feedback loop.
As COVID-19 pushes the industry into a new normal, the impact and involvement of technology in improving care comes along with it. From telehealth to enhanced patient engagement to virtual care, patients and providers are embracing technology at an unprecedented pace. To improve health outcomes and drive revenues as we move forward, a new approach towards referrals and reducing network leakage can work wonders for providers. The FHIR-Enabled Data Activation Platform assists you at each step in the process and ensures that stakeholders across the continuum can care as one.
To learn more about Innovaccer’s referral management system, click here
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