Curtis Gattis

home

authors

curtis-gattis

In the first part, we discussed four ways that value-based care can achieve seamless coordination and communication. Now we’ll take a deeper dive into the benefits of implementing a solution that will increase provider networks, provide detailed metrics on what’s working and what isn’t, and how narrow networks and value chaining set practices up for success.


Losing track of patients after they’ve been referred to a secondary care provider is a major problem for accountable care organizations (ACOs) and a common, recurring foundational mission for value-based organizations, making it an obvious starting point for improved care coordination and better referral management processes. Many ACOs lack the visibility to close the loop on manual, untraceable patient referrals and rely on outdated, retrospective claims data received too late to be meaningful and actionable. 

This lack of insight is harmful for patient outcomes and detrimental for the success of an organization created to deliver accountable care, as you have no way of holding providers accountable when referrals don’t result in appointments. When your organization is unaware of the number of patients that fall through the cracks or don’t get the care they were prescribed, you are likely unaware of the severe impact that lack of insight has on your organization’s bottom line.

Phase 1 begins with implementing and utilizing your connected communication network to enable referring providers to track patients in real-time to ensure they’re getting the care they need. This is achieved when you have full visibility across all digital patient transitions in your network. While traditional interoperability issues arise due to differing EHR systems, an agnostic layover platform circumvents those challenges. Connected organizations can send and receive referrals digitally, coordinate care via in-platform messaging, and share documents with each other.

Phase 2: Measuring metrics on performance and outcomes scheduled


Once your value-based organization is tracking the patient referral process and identifying where your referrals are going, this phase takes your care coordination capabilities to the next level. Knowing where your patients are is important, but creating throughput metrics to measure care coordinators, care teams, receiving providers and patients is the next step in ensuring your network is delivering higher-quality, lower cost care to your patients.

How Value-Based Care Can Achieve Seamless Coordination and Communication


Once your network has been built and are able to send and receive referrals, tracking what is happening using statuses is paramount to the success of your value-based organization. Being able to evaluate a range of insights from your platform is essential, including your referral-to-appointment ratio, referral trending or bottlenecks, referral network activity, and in-depth analysis of an organization’s metrics across the entire network.

From a cost standpoint, knowing what specialists and hospitals are within the patient’s network is of critical importance. Keeping better track of your patient pipeline benefits your PCPs as well by closing the referral loop on each patient. It also benefits specialists by improving the referral-to-appointment conversion ratio and most importantly, it benefits patients by ensuring their care is being carefully coordinated.

Phase 3: Narrow network and value chaining


In addition to establishing your tightly connected network and improving care coordination processes, ACOs and other value-based organizations must start to enforce narrow networks. As each patient is referred from one provider or service to the next, a “value chain” is created, which is a critical metric to monitor in order to keep costs in check while operating at scale.

Setting up value chaining starts with creating and mapping the providers across a series of plans. Plans are what drive the value chaining process and they are created by the central scheduling hub or parent organization. Patients referred within a designated plan help to limit the probability of referral leakage by directing referrals to stay within a specific network of preferred providers. The plan is what defines the network. Think of plans as a grouping of providers associated with something, usually a contract that depends on a patient’s PCP, employer, insurance, health system, or ACO affiliation.

With value chaining enabled, a plan must be associated with the referral before it can be sent. The plan also stays associated throughout the life of the referral, even if the referral is forwarded to multiple providers. The parent of the referral retains insight into where the referral has been forwarded to, from primary care to specialty providers to ancillary services. Referral coordinators no longer need to weed through hundreds of providers to send a referral to an appropriate provider. Within a plan, network and provider tags can be used to further define which providers or organizations are preferred. Using network and provider tags in concert with value chaining gives the referral coordinator more insight into where to appropriately route the referral.

Many value-based organizations find themselves stuck with data silos, disparate HIT systems, lack of visibility and other procedural challenges that impede their ability to deliver the highest quality care with the lowest possible cost. Refining, evolving and improving your care coordination and communication capabilities is paramount in delivering true value-based care.

Curtis Gattis is CEO and co-founder of LeadingReach, a healthcare platform and care coordination company in Austin, Texas. 

Articles

In this second part of a two-part article series, Curtis Gattis, CEO and co-founder of LeadingReach, discusses how healthcare organizations participating in risk-based contracting or value-based financial and care delivery models are currently facing major challenges with integrating, managing and tracking care coordination and communication capabilities within provider networks.

3 Ways to Reach Your Care Coordination and Communication Goals

Healthcare organizations participating in risk-based contracting or value-based financial and care delivery models are currently facing major challenges with integrating, managing and tracking care coordination and communication capabilities within provider networks. Poor coordination and communication not only cost the healthcare industry billions of dollars each year but also negatively impacts patient outcomes. 

In the U.S., about 80% of all serious medical errors involve miscommunication during care transitions to different settings, which results in costly readmissions, missed appointments, medication errors and other preventable harm. It’s fair to say communication in healthcare is broken.

For value-based organizations to manage costs and deliver better care to patients, it’s essential to identify care coordination and communication challenges and use communication and data-driven insights to overcome them. The goal is to improve processes, and the best way to do that is by connecting networks and bringing together disparate HIT infrastructure.

Why care coordination and connecting networks matter

As value-based care models continue to take center stage in the healthcare landscape, it is critical to manage referrals and ensuring that patients get the care they need in a timely manner at the “appropriate setting of care according to their health plan.”

Many organizations, regardless of their tenure or how far along they are in their value-based journeys, face key challenges that stunt their ability to consistently deliver the level of care they intend to provide. For accountable care organizations (ACOs) and other value-based organizations that aren’t satisfied or lack key capabilities in this area, addressing the challenges requires a reassessment of workflow and care delivery processes. In many cases, the success or failure of value-based care is largely driven by care coordination processes, which impact your ability to communicate and manage patient transitions and referrals.

Establishing an integrated network requires implementing the right tools upfront, and achieving this level of coordination has historically been a challenge given that most providers use different EHR systems. Full visibility across your network requires a stackable platform that sits on top of legacy EHR and existing HIT infrastructure to bridge data gaps and communication silos. Once tools are implemented to enable care teams to ubiquitously communicate internally and externally, it’s easier to identify where workflow bottlenecks are occurring. Identifying overarching operational and clinical care coordination and referral management goals are key to improving value-based processes.

Top 4 goals for improving care coordination

It is impossible to get a complete picture of your provider ecosystem when disparate EHRs cause data silos. However, when your network is connected using a digital platform, your organization will be equipped with insights needed to identify problem areas and opportunities for improvement. Here are four ways to solve care coordination problems:


Most manual, outdated communication processes have been digitized in every industry in today’s modern world except healthcare. More than 75% of healthcare’s referral-based communication are still sent via fax, but only 54% of faxed referrals result in scheduled appointments for patients and 25-50% of referring providers don’t know if their patients actually saw the specialist. Not only do value-based organizations struggle with closing the loop, but they are unable to hold providers accountable for the patients they should be seeing. By implementing a digital technology platform across your network, care becomes more accountable, traceable and coordinated.

Redirect referrals to in-network providers


Tracking and closing the referral loop is important, but tracking referrals becomes more valuable when you have full visibility into where specifically those referrals are going. Keeping patients in-network helps ensure patients get the most appropriate care from the most appropriate setting, while reducing the chance of network leakage. It’s great for the PCP to know their patient’s appointment was scheduled, but your organization also needs to see that the appointment was scheduled with an in-network specialist. This capability becomes accessible when you have a tightly integrated network of providers.


This goal speaks to the importance and need for digital communication to fully replace inefficient manual processes. With a staggering 63% of referring physicians dissatisfied with the current referral process due to lack of timely information and inadequate referral letter content, there is a massive opportunity to enable more informed, collaborative care for patients. Provider-to-platform direct messaging enables seamless and real-time communication.


This is the foundation of successful value-based care. If you can’t identify where your patient is, where they are going and the outcome of suggested care visits, you can’t ensure they’ve received the care they need. The primary value of a connected network is transparency and accountability for both sides of the referral with nothing slipping through the cracks. Updating and changing statuses on outgoing referrals is the simplest and best thing your referral network can do to ensure an accountable transition of care. 

Leveraging a referral management platform with a tightly integrated network of specialists allows you to move from a “rear-view mirror” management style based on claims data to a “windshield view” style. Making proactive, data-driven decisions is crucial to establishing your connected digital network and ensuring patients are receiving the care they need in a timely manner.

Curtis Gattis is the CEO and co-founder of LeadingReach, a healthcare platform and care coordination company in Austin, Texas.

In this first of a two-part article series, Curtis Gattis, CEO and co-founder of LeadingReach, discusses how healthcare organizations participating in risk-based contracting or value-based financial and care delivery models are currently facing major challenges with integrating, managing and tracking care coordination and communication capabilities within provider networks.