Background & Problem Summary

Organizations today are under intense pressure to better manage where their patients receive care. With value-based care initiatives, providers are now responsible for overseeing cost and quality measures for all their patients, even when they go out of network.

Studies show that health care organizations who practice timely and coordinated care transitions are more confident in their ability to provide high-quality care compared to organizations that do not. Without a care coordination solution in place, organizations may continue to deliver incorrect or duplicative treatments, which can lead to lower quality, costly delays, increased length of stay, and higher costs. Having a closed-loop referrals solution allows organization to eliminate time-consuming manual processes while providing a simple, innovative way to track, follow up and improve on transitions across an entire community of care.

Application Overview

Provide a closed-loop referrals solution to help providers effectively take control of their referral processes, enhance physician collaboration, and increase referral revenue.

The Referrals solution provides a secure way to manage patient referrals across your community and improve in-network utilization. It can streamline manual office processes by eliminating the need for faxing, back-and-forth phone calls, and waiting for appointment verification and results. The Referrals worklist feature helps manage and control the constant flow of incoming and outgoing referral requests and helps facilitate communications between care settings. Referrals also offers a comprehensive network management module to support multi-tiered and concentric networks. The module promotes an organization’s efforts to transition patients to in-network providers, so patients can be directed to cost-effective in-network options and receive the best care at the top of their benefit plan.

Benefits and Features

Reduce manual process and improve collaboration between care settings

Enables providers from different care settings to collaborate on patient care while eliminating the need for manual back-on-forth processes of tracking down needed patient information and referral status information.

Customize referrals questionnaires

Allows practices to customize their own referrals questionnaire and preferences, to ensure all pertinent information accompanies the referrals they receive.

Provides actionable worklists and notifications

Helps users track the progress of existing transitions and calls attention to specific transitions that require follow-up action. Configurable notifications for new and updated care transitions can be delivered via standard e-mail or text message.

Improve in-network utilization and patient retention

Provides a comprehensive network management module so providers can be associated with an organization or network, allowing patients to be directed to cost-effective in-network options, and receive the best care at the top of their benefit plan.

Monitor and track referral patterns

Reporting module provides administrative users a way to view referral activity and track referral patterns across their network.

Use Cases

  • referral coordinator at a specialty practice uses the referrals questionnaire tools to customize their referrals request forms to ensure they get the information they need to evaluate incoming referral requests.
  • primary care physician uses the Referrals solution to refer a patient to a specialist physician for treatment. Both providers can communicate about the referral request and collaborate on the patient’s treatment through the Referrals collaboration tools.
  • Patient is discharged and the hospital referral coordinator sends a request to a skilled nursing facility (SNF). The SNF referral coordinator receives the referral request, reviews the attached information, and accepts the request which automatically notifies the sending facility to help streamline the patient’s transition of care.
  • Patient is ready for discharge from a skilled nursing facility (SNF), and the SNF referral coordinator uses the Referrals solution to coordinate home health care for the patient.
  • A healthcare organization is looking to monitor, manage and capture data on network leakage, and the hospital administrator uses the Referrals reporting application to view referral activity and track referral patterns across their network.