Ensuring patients complete referrals and orders for specialty services is vital to the health of your patients and your organization’s financial health. Yet, according to the Medical Group Management Association, only 50% of referrals result in a completed appointment. Not only can this result in lower reimbursement, lower volumes, and disjointed care, but there is a huge demand for services that is not being captured.

How can we drive these referrals to completion and your patients kept in-network?

The answer is referral coordination. Referral coordination is using operations and technology to maximize your referral capture, minimizing outflow and leakage, and setting the stage for better outcomes. This idea is not new, but technology and best practice operating models have made it more possible than ever to apply it to your organization.

Here are some of the key areas to address:

• Assess your inputs – Understanding from where your patients are referred, or your “referral channels”, is the first step to developing your approach to referral coordination. If 80% of your referral volume is from internal, either hospital based or employed physicians, your strategy will need to be very different than if 80% of your referral volume comes from independent community physicians.

• Align your operations – Once you’ve accounted for all your inputs, it’s time to align your operations to capture those referrals. Take the time to understand the exact workflows and staffing needs required to effectively manage your referrals through each channel. A centralized department is often the most cost effective and easily managed model for supporting referral processing workflows, but variation can be accommodated depending on your referral base.

• Leverage your technology – Along with aligning your operations, you also need to align and optimize the technology to support turning those referrals into scheduled services. You need to ensure that all referral channels have appropriate systems and automation supporting them. For example, ensuring your community physicians have access to generate electronic referrals and your internal physicians are presented with preferred, in network, referral options.

• Create your referral coordination model – This includes three main components: 
  1. Referral generation and steerage
     1. Use your input, operations, and technology assessments and put them to work creating a model that allows you to track and steer patients to appropriate resources. Focus initially on high dollar, high volume areas to drive the highest returns.
  2. Time of service scheduling
     1. Scheduling patients during the visit when the referral was created dramatically improves referral capture. You’ll need to either create communication channels to a central group to schedule these visits or empower your clinic staff to schedule. Also consider how to promote this program with your independent community physicians. It can be as simple as providing the number for your central scheduling department.
  3. Referral completion notification
     1. Wrapping up the referral process with efficient communication back to the ordering provider is the important final piece of the referral’s lifecycle. That exchange of information promotes better outcomes for the patient and is a big satisfier for the referring physician.

• Use your EHR to drive dollars and accountability – With all referrals flowing through a standard process and common technology, empower your leadership and management of your newly aligned operations and referral process with the data they need to ensure the models overall and operational success. This can be achieved by creating a suite of analytical and operational reports from your referral management system, establishing standard KPIs and baselines, and assigning ownership.

The Wilshire Group has unique experience with implementing referral coordination models. If you are struggling with any of the above or want to talk about referrals and authorizations please reach out to Matt Perron and Freeman Jenkins.