Referral Management Program
The contemporary shift from fee-for-service models of care to value based care, demands that 1) patients are referred to the most appropriate provider in a timely, and seamless fashion, 2) patients receive the level of care they need, and 3) providers initiate precise transitions of care to ensure the provision of high quality care and avoid the negative effects on cost and quality performance scores. Unfortunately the current system of referrals does not satisfy these demands, and is characterized by some glaring deficiencies with clear adverse consequences. To be specific, the current referral system is marked by:
- Narrow and preferential referral patterns.
- Patient leakage, especially during patient transitions of care.
- Clinically inappropriate referrals.
- Delayed care resulting from a slow and time-consuming referral process that fails to close the loop on a referral.
- Limited referral tracking.
- Low levels of satisfaction among physicians in referral process and the quality of physicians to physician communication.
- Increased medical errors due to poor communication.
The GHS Referral Management Program:
1. Generates periodic reports by provider/practice, including type of specialist referred to, patient name and diagnosis.
2. Facilitates e-consults with defined network specialists.
3. Consolidates all referral communication from fax, phone, and website and from other users into one centralized location.
4. Provides aligned providers with decision-support tools to ensure that they send appropriate referrals that meet specific criteria (insurance, affiliation, in-network provider, proximity to the patient, referral details, and medical records, etc.).
5. Establishes referral guidelines for all providers.
6. Automatically sends out appointment status reminders and referral progress updates to referring providers.
7. Provides robust analytics for monitoring referral trends, volume, status updates, payer mix, service levels, wait times, competitor volume, referral leakage.
8. Expedites sending and receiving referrals with any size file attachment including video, excel, PDF, medical records, DICOM images, and CCDs.
9. Informs primary care physicians and extenders when inappropriate referrals are made to prevent future recurrences and unnecessary appointments leading to increased costs.
10. Ensures that providers adequately prepare their patients for their referral visit and for what to expect afterward.
11. Enables transparency between provider post-visit regarding findings, next steps and treatment plans (including notifications of no-shows and cancellations).