For years, effectively managing network referrals has been important for ACOs. However, a progressive ACO must acknowledge that effective referral management can impact much more than being able to monitor network leakage.
With CMS and commercial payers offering multi-factorial incentive plans, ACO leadership must have the appropriate data and information to dig deeper, to get to the root of performance issues. Our customers and other ACOs have learned that a robust referral management system can help the network monitor key metrics including patient satisfaction, referral time to initial visit, time from initial visit to post-visit documentation.
Digging deeper to better understand each of these metrics and the factors contributing to each of them can help ACOs identify issues, understand why those issues exist and put solutions in place to address them.
Exploration of these issues may highlight some of the following needs:
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To streamline the patient referral and appointment scheduling processes
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To better educate physicians, care coordinators and patients about network capabilities and the benefit of staying in-network
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To provide additional training and support to ensure that referral coordinators adopt/adhere to approved tools/processes
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To track practice performance to ensure proper compensation, and hold practices accountable against shared ACO goals
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To understand network utilization to expand ACO network capabilities, provide additional resources and/or specialties/services in response to patient needs/volume, or expand the geographical reach of the network
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To implement new communication and collaboration technologies and protocols:
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To ensure a consistent (two-way) exchange of information throughout the patient’s care journey
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To close the referral loop, to ensure the patient stays in-network, ensure better care coordination, and manage costs
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To collect better information about the patient experience
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To implement other tools to support better patient engagement and care management
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To compare referral data to claims data to ensure proper reimbursements
Participating PCP and specialty practices can also gain key insights from a referral management system that can help them optimize:
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Impacting patient care plans
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Improving patient education
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Enhancing staff training and guidance
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Understanding how well their practice and their referral coordinators are meeting the ACO goals.
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Understanding how quickly appointments are being scheduled and how quickly patients are being seen, as well as how long they are taking to close the referral loop
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Understanding who they are sending referrals to or receiving referrals from, and why
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Understanding staffing needs and performance, including referral coordinator efficiency and performance.
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Knowing when they are at risk of not meeting ACO goals and guidelines
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Managing total cost of care
Proficient Health offers solutions that help ACOs address these issues and perform at their highest level. Part two of our blog series will explore current Proficient Health customers who are utilizing our solutions to support faster and better-coordinated care delivery.