By Mark Cittadino, Head of Health System Sales, AristaMD
Expansion strategies vs. improved referral management
When a healthcare organization seeks to increase connections to its community or expand its service area, one strategy is to add primary care physician (PCP) practices to its network. A health system may also consider mergers, acquisitions, institutional affiliations, or participate in clinically integrated networks or similar structures as ways to accomplish the goal. These strategies increase patient access to the network’s offerings, build connections to specialists of all kinds, and enhance the organization’s negotiating power with insurance plans and purchasing departments.
However, recent data shows that “brick and mortar” practice additions or merger and acquisition expansion strategies have inherent problems. Such approaches consume substantial organizational resources, including time, energy and finances, and can also result in redundancies within the system if a targeted acquisition offers similar services. Expansion can actually complicate care delivery without necessarily increasing the value of care patients receive.
These acquisition-based expansion strategies also don’t effectively address referral management challenges, such as out-of-network referrals and other forms of referral leakage. This is key, because while referrals often greatly strengthen health systems, referral-related issues can have the opposite effect.
Referral leakage is a primary referral management problem
Referral management is packed with challenges. When referrals are poorly managed, long waits for specialist appointments are common. Patients who need specialist care are often incorrectly matched with the appropriate specialist. Coordination among providers can be unwieldy, and communication between practices often breaks down. The latter is so common that the majority of specialists report receiving little to no information from PCPs prior to patient referral visits. The entire referral process has been described as “a long-standing source of frustration among physicians.” And, even when the physician-to-physician process works well, many patients don’t act on the referrals they receive.
However, of all the referral-related challenges health networks face, referral leakage is one of the most concerning, and it may be the most intractable.
Why is leakage so important? Losses to networks include:
- Long-standing and shorter-term patient relationships
- Connections to referring providers
- Control over care coordination
- Ability to regulate cost and manage health outcomes
Effective referral management benefits networks, clinicians, and patients
Until now, healthcare organizations assumed referral leakage was a cost of doing business. Any leakage increases related to network expansion were accepted as a tolerable risk.
The advent of eConsult platforms changed that assumption dramatically. These tools are being recognized as a new and very effective approach to referral management and network expansion, a way to minimize leakage that has numerous ancillary benefits. Organizations are adopting eConsult platforms because they are convenient, highly data driven, and easily integrated throughout their networks.
eConsult benefits to health networks and systems include:
- Ongoing ability to expand networks and geographic footprint in lieu of acquisitions
- Capturing more of the care continuum
- Enhanced referral coordination and operational effectiveness
- Identifying willing PCP partners for practice acquisitions by raising the value of network participation for those PCPs
- An ability to capture more patients from within the local or regional vicinity through referrals
- Greater patient retention in the network when face-to-face specialist visits are required
- More appropriate use of specialists and emergency rooms—“right patient, right time, right setting care”
The last point is particularly important. A well-designed eConsult platform can not only enhance overall referral management, it can ensure that the patient receives the appropriate type of care at the right time. This is vital for operational efficiency and clinical effectiveness within networks.
In addition, eConsults have been proven to:
- Help physician networks grow and prosper, supporting health system efforts to capture nearby patients and them in referral cases
- Significantly increase primary care capacity and patient access
- Help both PCPs and specialists work at top of license by enabling effective PCP management of low-acuity patients and improving access to face-to-face consultation with specialists when appropriate
- Comprehensively meet providers’ needs for better referral management and retention
- Improve overall referral management and network efficiency
Leveraging an eConsult platform as a referral management strategy ensures lower-acuity patients can secure timely specialty care while remaining within the primary care setting. Also, high-acuity (higher billing value) cases flow through to network specialists, maximizing revenue pipelines and improving access to care.
Delivering across-the-board benefits
When PCPs and specialists consult electronically, patients receive direct benefits, including:
- More appropriate and focused care from PCPs
- Better coordination between their PCPs and needed specialists
- Improved access and decreased wait times for face-to-face specialist appointments
- Increased likelihood patients will receive all required workups
Primary care practices enjoy countless benefits from electronic platforms. Implementing eConsults often creates higher primary care capacity and greater patient flow. More patients can mean a greater—yet still entirely appropriate—volume of tests, procedures, and other services. Electronic consults also can:
- Increase and strengthen relationships between PCPs and specialists
- Boost PCPs’ contact with individual patients
- Help PCPs more effectively change patient behavior
eConsults support the entire basis of primary care, empowering PCP practices to serve as the central hub and entry point for patient care.
Specialist practices may reap even more advantages. Streamlined and timely access to care for patients can result in many new patient opportunities. Specialists may also gain time to see patients face-to-face, and may be able to perform more procedures. In addition, specialist practices that use eConsults usually increase their percentage of complex, high-acuity cases, which can mean enhanced revenue. And many surgeons experience a higher surgical/procedural yield.
Also, while no-shows for face-to-face follow-up specialist appointments have historically been all too common, many practices are finding that eConsults effectively control that problem.
Choosing new and more effective solutions
Instead of relying on problematic expansion strategies such as mergers, acquisitions, and institutional affiliation strategies, health systems are moving toward the synergistic advantages of eConsults and are seeing benefits for everyone involved.
Electronic consultation platforms can capture more patients, build better relationships, and increase operational effectiveness compared with acquisitions. Networks are finding that eConsults supply the highly effective solutions they need to succeed.