Fixing the Hole: Using Data and Technology to Reduce Preventable Patient Referral Leakage
// By Althea Fung //
Picture this: A patient goes to her primary care physician with complaints of dark, dry skin patches on her arms. The doctor, who is a staff physician at a large health system in New York City, quickly determines that she has acanthosis nigricans and prescribes a topical ointment. The doctor also suggests she see an endocrinologist to determine if the condition is associated with an endocrine or hormonal disorder. As the patient prepares to leave the office, the front-desk attendant hands her a referral to an endocrinologist — at a competitor organization.
While there are many good reasons why the doctor might have referred the patient to an outside physician, from an organizational standpoint this occurrence — known as referral leakage — is bad for business. Organizations lose on average $780,000 annually per employed physician that refers out of the health system, according to ReferralMD, a physician referral management organization. That translates to an estimated $200 million to $500 million in lost revenue to competitors each year.
Arizona Care Network (ACN), a Phoenix-based accountable care organization that partners with Dignity Health, Tenet Health-owned Abrazo Community Health Network, and independent providers, saw referral leakage as a problem that could be easily solved.
“For a provider network to be successful in value-based medicine, it must coordinate patient care across the entire continuum of care,” says Debra Stevens, executive director of marketing and communication at ACN. “This is a complex effort, requiring collaboration among facilities, providers, and services using technology, data, and analytics to achieve our goal of improved health outcomes at a lower total cost of care. Also, CMS, through its implementation of MACRA, has placed a strong emphasis on coordinating services within an ACO.”
Read our latest article to find out what ACN did to drive monthly referrals from 1,200 to 5,400 in less than a year.
Using Technology to Address Referral Issues
Comprising more than 5,500 providers in more than 1,800 locations throughout the Phoenix area, ACN decided to take aim at the 60 percent of patient spending that occurred outside of the organization.
Part of ACN’s strategy to achieve reduced referral leakage was the launch of a comprehensive active referral management program in early 2017. Using the par8o platform, a cloud-based patient referral management software, ACN primary care providers (PCPs) were able to refer patients to ACN specialists.
The par8o system matches patients with in-network providers, determines whether the individual providers accept the patient’s health insurance, and reports the distance from the patient’s home or primary care physician’s office to the specialist’s office. The system also tracks care notes from the PCP and the specialist. par8o is one of several referral management systems currently on the market.
Stevens says: “The specialists’ offices receive the referral and log their actions. This allows the referring PCP to know whether the patient has followed through on the recommended care plan, thus improving outcomes. Following the appointment, the specialist can post his or her notes, diagnosis, and care plan, which improves communication among each patient’s care team.”
As par8o can be used by practices in and out of the ACN network for all patients, including those not currently seeing an ACN provider, the Arizona Care Network team saw the software as a “powerful tool to improve practice adoption and provider satisfaction.”
Communicating to Increase Adoption
To encourage physicians to enroll, ACN took a multi-pronged approach, Stevens says.
“Our primary communication goal was to achieve 90 percent practice adoption of the par8o platform, leading to an increase in in-network utilization for ACN patients,” she says. “We used a variety of provider communication tools to educate, launch, train, and reinforce use of the software by all relevant members of the practice. This included email newsletters and bulletins, webinars, testimonials, quarterly Pod Meetings, messages on our secure portal, practice manager forums, and practice visits.”
ACN also revised its incentive program — Provider Rewards, which now ties 60 percent of the incentive to software utilization metrics. “This aligns focus on and incentivizes provider actions that support better outcomes at a lower total cost of care,” Stevens adds.
In addition to focusing on communicating to providers, Stevens says, practice staff were a secondary audience to aid in program adoption. Provider Network Consultants serves as technical support technicians, training practice staff, running a “help desk” to troubleshoot issues, and visiting practices regularly to ensure the software is being optimally used.
Program Outcomes
In the first year of the launch of the program, approximately 90 percent of practice locations in the Arizona Care Network were using the software. ACN reports 78 percent of all referrals made within the tool were made to ACN providers, including referrals from non-ACN member doctors. Accounting for only ACN members, that number increases to 86 percent.
Additionally, the organization was able to reduce the average time for a practice to take action on a referral from 51.21 business hours to 15.37.
“At launch (February 2017), monthly referrals were 1,200. By the end of the year, monthly referrals had reached 5,400,” Stevens says. “Ultimately, this multi-pronged approach has contributed to our goals of improving care, reducing total cost of care, improving provider satisfaction, and driving a positive patient experience.”
Providers and practice staff can review their referral data as well as stats for the entire organization on a secure online portal.
Top-Down Program Alignment
Stevens partially attributes the success of the program to buy-in from leadership and member organizations.
“Our network is composed of providers employed by our owner health systems as well as independent practices. In systems like Dignity Health and Abrazo, physician leadership drives behavior change — we have those leaders on our board of managers,” she says. “They had insight from the very beginning into the value of our Active Referral Management and approved the entire plan.”
ACN continues to fine-tune the program based on provider and practice staff feedback. As Arizona Care Network continues to grow, new practices are required to send and receive referrals through the online tool as part of the newly updated provider participation agreement.
ACN also is updating the referral search algorithm to award greater weight and ranking to providers who respond quickly to the referral request and schedule the referral appointment within the recommended time frame. Stevens says, “This aligns the priorities of the primary care provider, improves access to care, and drives patient satisfaction.”
Althea A. Fung is a digital content strategist and health care journalist. She is a senior editor at NewYork-Presbyterian.