The Future of Referral Systems: Closing the Loop

   

referrals

Referrals have long existed to facilitate services. Primary care physicians refer patients to oncologists for cancer-related care. Housing agencies refer individuals to local service organizations for housing-related needs. And of course, healthcare organizations refer patients to social service providers when social needs are identified.

Referrals have been and always will be a critical component of care delivery, but in order to successfully complete referrals, infrastructure must be utilized to close the loop on referrals and successfully achieve service delivery.

As payers and providers shift to a value-based model, closing the loop on referrals is going to become a greater necessity – and Healthify, powered by WellSky, is leading the way with a closed-loop referral system that spans the care continuum.

Incomplete referrals lead to fragmented care

Many barriers stand between patients and referred services. A referral may be directed to an inappropriate service. A patient may not qualify for the recommended service or they might, but their insurance doesn’t cover it. The care may not be as great as the provider expected. The recommended provider may not have the capacity to serve that patient. The patient may not show up to the service. Maybe they forgot or they don’t have access. Some referrals simply get lost or neglected.

Millions of referrals are made every year and far too many go uncompleted. Even with advancing technologies, many providers still rely on the traditional and outdated paper-based method. Handing out a name and a number, printing out a long list of organizations, or faxing a referral can be beneficial, but the process is inefficient, slow, and ineffective.

A 2017 study found that 50 percent of all specialty referrals (which are made between clinicians and specialists) aren’t completed due to miscommunication, misdirected referrals, or missing information. This doesn’t even account for capacity strains or the ambiguity of roles. When there’s fragmented care, it causes a delay in diagnosis, treatment, and care, causing poor or worsened health outcomes.

Referral networks make closed-loop referrals possible 

Referral networks are integral to filling gaps in services and have long existed, both inside and outside of the healthcare system. Nearly every provider has a network of specialists they can recommend to patients and at any organization, you’ll find a long list of peer organizations, either on the wall of the office or in a shared spreadsheet on the desktop. But how many of these referrals are successfully completed? How many healthcare providers call local food banks to see if their patients received a food box? How many check in with their patients to make sure their non-medical needs have been properly addressed outside of the healthcare system?

The most successful networks have built-in workflows, in which patient data can be gathered and shared in a timely and secure manner. In a social services referral network, this process can be complicated. Not only do you have cross-sector partners, but you have different stakeholders with different goals and expectations. Establishing trust is just as important as building interoperable technology to support the referral process.

At Healthify, powered by WellSky, we’ve learned that referral networks are most effective when there’s shared responsibility and accountability between network providers. This is why we build preferred networks, in which healthcare and community-based organizations join in a contractual and mutually-beneficial partnership. Our preferred networks ensure the delivery of information and services across a wide range of diverse partners and provide payers, providers, and community-based organizations with the data needed to adjust their SDoH strategies, build cost-effective solutions, and secure more reliable funding for their organizational operations.

Closing the loop with Healthify

As a result of our continued efforts to improve care coordination across the continuum, we’ve reached a 67 percent closed-loop referral rate in our preferred networks. We know referrals are only as effective as the system in which they are passed and we are thrilled to be able to support our partners with interoperable technology that protects the privacy of patients while driving better care coordination.

As a member of the WellSky family, we are excited to bridge the gap between the state, payer, provider, and community-based organization. Working across the care continuum, we look forward to being the go-to provider for a patients’ health-related needs.

To learn more about our new partnership and what it means for you, schedule a demo today.

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