Outsourcing: enhancing your referral process

35, 46 and 75 — These numbers may not seem related, but they’re most likely affecting your practice even today.

Referrals are a major factor in running a successful medical practice, yet it has been reported that only 35% of referrals result in completed visits. Physicians who participate in health information exchanges see a 46% increase in physician referrals. And 75% of patients reported that they search for a physician online when trying to find quality care. So how can we utilize this data to streamline the referral process for primary care providers (PCPs) and specialists alike?

The pitfalls

PCPs and specialty groups can find it challenging to get referrals to ensure continuity of quality care. For PCP offices, the legwork to coordinate care may at times outweigh the benefits when patients don’t follow through, they are dissatisfied, or specialists’ values don’t align with your own. In comparison, as a specialist the amount of time and energy it takes to get that extra referral each month may seem overwhelming and not worth it when you analyze the work and follow-up needed for that visit. In both settings, outsourcing can be a viable solution to alleviate the burden of comprehensive continuity of care.

PCP optimization

Having a workflow that combines your broad expertise with your patients’ needs can result in increased patient satisfaction and better clinical outcomes. Consider this example:

A primary care practice has been serving patients in general medicine for the past seven years. The practice has seen an increase in more complex conditions but has not been able to develop a quality referral process. Although it is contracted with major payers, the practice refers patients primarily based on geography, the success of which often cannot be tracked. After working with an outsourcing consultant, it executed a plan to enhance its referral program while monitoring its efficacy.

The practice starts by utilizing a full-time remote resource whose primary role is care facilitation. With a background in communication, this resource creates and executes a workflow that covers five areas:

1. Maintaining online presence through education
2. Tracking and reporting of quality specialists
3. Provider-patient-specialist coordination
4. Medical documentation facilitation
5. Closed referral loop management.

The remote resource does a thorough review of the practice’s online presence. She starts with a social media analysis, ensuring online content is up to date, informative and actionable for patients. She then works with the practice to create and maintain a content calendar to ensure daily updates are made and tracks the engagement across all platforms including the practice’s website.

Benefit: Patients are easily able to locate the practice when searching for care.

Through its EHR and internal system, the practice’s next focus is maintaining a list of all specialty groups within a 50-mile radius of the office. Although patients’ residence may be close to the practice, having a broader reach allows more scheduling flexibility and provides more options for patients based on their daily routine. They collate data on the offices to include specialty, provider bios, languages spoken, hours of operation, patient ratings and reviews, insurance accepted and practice perks, which includes extended and/or weekend hours, same-day appointment for new patients, flexible payment options and a website/online presence. While this amount of data may seem overwhelming, the remote resource utilizes transparent and user-friendly software that can be easily understood by providers and staff. With referrals, the system will be used to track the number of patients, appointment follow-through and patient satisfaction.

Benefit: Having an impactful yet customized platform where data can be understood and acted upon can alleviate the stress of monitoring a referral program.

Once it is established from the provider that a referral is needed, the remote resource will be responsible for communicating with patients regarding details of the referring options. She will take note of special patient requests such as preferred languages, appointment times, type of doctor or setting, and concerns patients may have regarding their first visit with the specialist. The remote resource will also obtain feedback on the referral process, which will be shared online for other patients to see.

Benefit: Patients have more time with someone to explain their options while also ensuring the right care is made available to them.

Next, the remote resource will coordinate directly with the specialist and follow up to ensure appointments are kept. Prior to the visit, the remote resource will ensure all pertinent clinical information is sent to the specialist and all questions are answered. Within 24 hours of the appointment, the remote resource will follow up with the specialist and patient to obtain feedback on the visit and any additional information needed by the PCP to ensure the best outcome.

Benefit: The specialist can be prepared to offer the highest quality of care while ensuring the patient is informed every step of the way.

From all modes of communication, clear and actionable documentation will be made in the system for monthly reporting for the practice’s stakeholders. By doing so, potentially negative feedback from patients or specialists can quickly be addressed and rectified.

Benefit: As data is collected and analyzed, practice decision-makers can support the efficacy of the program and show how it directly improves patient satisfaction and clinical outcomes.

With this model, patients can expect a higher level of excellence. The practice’s providers no longer have to worry about following up with specialists and providing medical documentation. The online presence can be enhanced with real-time reviews, ratings, content and posts. Strategically implementing this with remote support is a value add to the practice and its affiliates.

Remote support can also be advantageous for other areas of the referral program, including specialists. Stay tuned for the next article when I will examine the workflow for specialty groups and how to gain the highest returns for their efforts.

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