Referral management is often an underutilized strategy for value-based care and fee-for-service models. Recently, ReferralPoint Operations Director, Matt Cheatham, discussed just that on the blog. Today, the referral process in healthcare is far from efficient due to subjective data, manual processes, and disconnected tools. For example, network leakage and referring to high-cost specialists cost nearly half of all provider groups 10% more of their annual revenue. Without a method to control referrals or close the loop, health systems, employers, payers, and providers stand to lose even more from patients leaving the network for specialist care.
I spoke with Matt about this topic on our most recent episode of the Population Health Management Podcast, alongside one of Lightbeam’s Clinical Transformation Advisors, Alexis Edwards, BSN, RN. We discussed the importance of effective referral management and how Lightbeam can support referral care management programs and even automate much of the process.
Matt and Alexis, thanks for being here with us today. To start, could both of you tell us a little bit about your roles here at Lightbeam?
Alexis: I am a registered nurse and a Clinical Transformation Advisor in Lightbeam’s Clinical Transformation department. The department is made up primarily of nurses who help our clients facilitate cohesive care management. Translating insights into action, we help their staff craft impactful initiatives, scalable workflows, and provide ongoing consultative engagement.
Matt: As the ReferralPoint Operations Director for Lightbeam’s referral solution, I help clients harness their data to build and understand their populations’ best clinical referral networks. My role starts with understanding each client’s goals and vision regarding their referral workflow by analyzing the networks they already have in place, or we start from the beginning and help them build an ideal specialist network.
I read an interesting statistic from The Milbank Quarterly in the US National Library of Medicine National Institutes of Health search database. In the United States, more than a third of patients are referred to a specialist each year, and these specialist visits make up more than half of all outpatient visits. Alexis, can you expand upon the struggles of care teams who do not have visibility into their referrals?
Alexis: Absolutely, this is one of the primary reasons Lightbeam created the referral management module and team. Many care teams might not know or have the resources to select the best in-network provider or facility or handle the documentation. These barriers are compounded by a definitive lack of visibility into the outcomes of referrals. Referrals represent critical care transitions into a patient’s health and can indicate the long-term worsening of their results.
Communication is critical, and between disparate electronic medical records (EMRs), appointment delays, time constraints, and other factors, many loops are left open until the patient is seen again. Given these factors and more, there is a greater probability of preventable hospital admissions.
What do you both recommend for groups that do not currently have a referral network in place?
Matt: Well, the most immediate need is implementing a way to track their referrals and understand them using their data from the beginning to the closed-loop. Trying to manage referrals without data is like crafting an initiative without a defined group to target.
If a client has not built a network, we can build one through in-depth analysis of their claims data, market, rural or urban, and patient population. We also can always modify based on any referral trends and patterns we see. We have substantial data to analyze and review the networks built by clients based on their payer contracts, goals, everything. From there, we work with the referral teams to determine the best workflow and customize where needed. Once we are operational, we analyze and monitor the referral activity and patterns to optimize the networks and patient experience.
Alexis Our clients have complete access to their data, analytics, and modules. Both care management and referral management modules are end-to-end solutions that are highly beneficial for providers and their patients. The Clinical Transformation team also helps clients create measurable care management programs that offer visibility into the referral life cycle while demonstrating thoughtful care coordination.
In many studies and through experience, we see a 30/70 rule with patients regarding referrals. Approximately 30% of patients who have a simple referral from another provider will attend a specialist appointment. In comparison, 70% of patients in a true referral care management program will attend at least one appointment, regardless of diagnosis or age group.
Matt, how does Lightbeam work with organizations to manage the referral process?
Matt: We have an automated referral coordinator tool that can text patients with the address, phone, and other contact information of the referred physician. The tool can also follow up with the patient to ask the appointment’s date and time, which allows us to see if the patient scheduled the appointment as part of the referral tracking process. We also can remind and follow-up with them. Lastly, the tool allows them to write a response asking how the appointment went, which is one way we promote our dedication to satisfaction and quality. If the client wants, we can leverage these patients’ ratings into the specialist’s overall network grade.
To schedule an introductory call with the Referral Management team, email mcheatham@lightbeamhealth.com.
Explore more resources below:
CMS Innovation Center – Managing Referrals
Lightbeam Referral Management Website
Laurel Derr is Lightbeam’s Marketing & Event Coordinator.