Healthcare Collaboration Point for CIOs: Referral Management
Helping consumers navigate follow-up care is essential under value-based models, but disjointed payer and provider referral processes are inefficient and frustrating. U.S. healthcare payer and provider CIOs must collaborate to improve their collective referral management workflows and IT systems.
Download this report to learn more about the following key findings:
- Disjointed actions, confusing rules and long delays characterize current referral management processes between U.S. payers and providers.
- Stuck in the middle, consumers must navigate convoluted care delivery processes, coverage limitations and medical terminology to coordinate their own care.
- Providers prioritize patient throughput, clinical appropriateness and revenue capture when making referrals — downplaying consumers’ health plan benefits, cost sharing and coverage criteria. Payers deny claims as a result, driving up providers’ bad debt and further frustrating consumers.
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Healthcare Collaboration Point for CIOs: Referral Management, Bryan Cole, Jeff Cribbs, Mandi Bishop, Mike Jones, 19 March 2019