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Care Continuity on the Road to Value: One Solution to Three Challenges

June 18, 2021



Healthcare organizations will emerge from the pandemic into a reshaped landscape. Virtual and retail access to care has exploded since the crisis began, and consumers will continue to embrace these new doorways to care. Risk-based contracting is accelerating. And recovering lost volume is an urgent priority for every health system.

Which priority will your organization tackle first?

The good news is that focusing on referral management as part of your strategy for optimizing care continuity can address all these priorities. Keeping patient care delivery in your high-value network is the first and the last step to managing quality under risk and recovering volume. And doing so relies on creating a frictionless patient experience for consumers that compares to the ease of access offered by virtual or retail care. Streamlined, effective referrals are a pillar of population health management on the road to value.

  1. Standardized referral workflows streamline high-value, quality care

Overall in-patient volume at hospitals dropped 50% and outpatient visits by 64% in the first months of the pandemic, according to the Healthcare Financial Management Association. A year later, volumes are rebounding, but consumers may not be returning to the same sites they’ve gone to in the past for care, which places risk on the organizations care continuity efforts and can create waste through un-coordinated patient management. Now is the time to reestablish connections with past patients to address more consistent outcomes— and to grow by connecting to new consumers ready to seek care again.

Maintaining high-value patient care delivery within a network is not a new challenge for health systems. In a post-pandemic world, however, in which consumers have more choices for care, you have even more risk to care continuity. Successfully achieving continuity of care requires overcoming multiple barriers, from technology to physician culture. Yet referral management provides a single, holistic path not only to network integrity but also to meeting your financial objectives under both traditional and risk contracts.

Begin by streamlining how referrals are managed by physicians and care coordination teams. Inefficient processes overburden staff and cause delays for consumers, increasing the likelihood that they’ll seek out specialist care elsewhere on their own or not follow up at all, creating a gap in care. Lacking an easy approach in their workflows, physicians will rely on habit and personal networks to make referrals or simply leave the decision to consumers by sharing unweighted lists of specialists. The right strategy, however, can simplify and standardize referrals in the clinical workflow, reinforce the organization’s referral policies, and support best practices and quality. In short, to succeed, making an appropriate in-network referral must be the easiest part of a provider’s day.

In defining your overall care continuity strategy, it’s essential that referral management does more than refer. A comprehensive referral management program combines technology, analytics, and best practices. In the transition to value, referral management means closing the loop: enabling information sharing and communication between referring and specialty practices to promote care continuity and better patient outcomes. This holistic approach will not only ensure that consumers are acting on referrals but also collect data on physician referral behavior, help PCP and specialists identify patients needing follow-up, monitor quality and utilization initiatives, and capture quality metrics for value-based contracts to ensure reimbursement.

  1. Referral management and value-based contracting share a common goal: continuity of care

Meeting quality metrics required by risk-based contracts relies on closing the loop in referrals. By keeping primary and specialty care delivery within the high-value network, you can capture both contracted metrics and more data across the continuum of care from physicians who are aligned with your standards of care. Those complete data sets provide the longitudinal visibility needed for predictive analytics and proactive targeted preventive care for at-risk populations, as well as identifying which service lines are seeing low utilization.

Because physicians drive referral decisions and patterns, educate them on the intersection of referrals and value-based contracting as well as the continuity of care benefits their patients will see when they keep their care delivery within the high-value network. Optimized referral management embeds referral workflow and communication tools into clinical workflows to support decision-making at the point of care and standardize workflows. Data on care gaps and at-risk populations are richest when care is coordinated by network providers, enabling them to deliver on value by effectively managing the quality and the cost of care.

  1. Referral management is your arrow in the quiver for providing a more personalized consumer experience

Consumer experience will be the ultimate decider, and referral management is an extension of the overall care experience. Inefficient referral management can delay specialty care and inhibit care coordination. People who wait too long for an appointment will go elsewhere — and their options for finding alternate, immediate, and convenient care are growing. Or they may skip getting care at all, creating a care gap in your quality metrics. Their expectations for timely care post-pandemic are higher. As ambulatory and virtual options increase for consumers, it is essential to not only convert referrals quickly but also evaluate access points for care delivery within your high-value network. Does your referral management approach help make the referral process and appointment scheduling convenient and easy for consumers? Does it help simplify and personalize the care experience rather than tasking consumers with long drives to specialists who don’t understand their care needs? Does it help the physician quickly match a specialist to the needs of a consumer, encouraging follow-up for improved outcomes? Meeting consumers where they are with ease of access is part of referral management, too.

When a system makes care easier for consumers to access, it can also help improve care continuity and the care experience, minimizing potential threats from competitors even in consolidating markets. In the shift to outcomes-based care delivery, connect with consumers at all points across the continuum by enhancing care coordination and continuity of care capabilities. Effective referral management built on a consumer-centric experience, physician support, and data-driven, tech-enhanced performance management enables high-value, clinically integrated networks to compete — and thrive — in a post-pandemic world.


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