Population health insights

The technology factor in referral intelligence

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May 02, 2018

In my previous blog post, “Advance your referral intelligence,” I discussed how objective data can be used to help enhance the patient referral process for healthcare providers. But once you’ve identified patients who require evaluation by specialists, how do you motivate them to follow through with their consultations? And how do you continue to ensure that you’ve aligned them with the most appropriate in-network physician or surgeon for their situation?

 

That’s where an automated referral management process can help.

 

Philips is teaming with Fibroblast to offer web-based software for streamlining the referral process and supporting the last mile of patient referral coordination.

 

More than just a way to send referrals, Fibroblast’s unique approach is tightly aligned with population health management (PHM) and value-based care goals and objectives. The platform uses proprietary algorithms to help guide physicians’ referrals to the most appropriate in-network specialists, bringing cost-savings and quality-conscious automation to a process that’s too often been based on the subjective or historical patterns I detailed in my last post.

 

It also connects to the electronic health record (EHR) workflow, so providers and staff can use the platform without leaving their EHR.

 

Fibroblast offers data about a specialist’s patient ratings, health-plan participation, availability and other factors, so providers can refer their patients to the most appropriate in-network specialist before the patient even leaves their office.

Considering the business case

It’s important to note the significance of taking a critical eye to patient referrals in today’s healthcare environment. An analysis of Fibroblast’s MSSP ACO beneficiary client base notes that health systems previously lost up to $492 million in revenue to out-of-network competitors.

 

And within payment models, such as ACOs and MACRA bundles, public and private payer quality programs often offer rewards to organizations that can manage their referral patterns to achieve better patient outcomes and lower costs. Using an automated tool to build and manage a high-performance referral network can help providers to increase revenue, reduce value-based risk and better meet these advanced alternative payment model metrics.

New CMS rulemaking on referral loops

In addition to existing payment models, CMS on April 24 announced its new revamping of the meaningful use program for hospitals. The proposed rule creates a new Health Information Exchange objective with two measures focusing on “supporting electronic referral loops.” The measures score both the sending and receiving of health information within referrals. The new measures are to take affect no later than 2020.

Patient and provider benefits

Fibroblast’s cloud-based platform algorithmically scores providers based on specialty needed across cost, quality, location and other variables, ensuring a patient is aligned to the right provider at the right time.

Among other things, Fibroblast helps healthcare providers:

 

  • measure their referral network’s performance with real-time analytics;
  • manage their referrals with rules-based workflows and scheduling;
  • keep their patients on track with eConsults, reminders and care coordination;
  • organize their referral network data into one, unified directory for optimized scheduling and workflows.

Patients can also benefit from this data-based approach as Fibroblast estimates a 19 percent increase in patient access to network specialists. The platform can generate follow-up emails, texts and appointment reminders to guide patients through the referral process, while allowing their primary care providers to track their progress at the same time.

 

Ultimately, giving providers data-driven insights about their referral patterns, and using data analytics to better guide in-network referrals, are needed functionalities in PHM processes impacting clinical and financial outcomes.

About the author

Paul Taylor
Paul D. Taylor, MD, 
CMO, Philips
Paul D. Taylor is CMO for Philips PHM. Board-certified Internal Medicine physician and entrepreneur with experience developing industry-leading Value-Based Care and Population Health Management solutions and implementing clinical quality improvement programs and systems of care at the physician, physician group, physician organization, and community levels.

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