Preventing Patient Leakage With In-Network Referrals

In the shift to a value-based care model, healthcare organizations must deliver cost-effective, quality outcomes across the spectrum of care to individual patients and patient populations. To succeed under value-based care and programs such as the Affordable Care Act (ACA) and the Medicare Access and CHIP Reauthorization Act (MACRA), health systems have begun to consolidate. Consolidation allows healthcare networks to leverage technology innovation, share risk, improve care coordination, and offer greater patient access to clinical services.

With the rise of large healthcare systems made up of hospitals, primary care facilities, outpatient facilities, and ancillary services comes the opportunity to create a greater care team of providers from multiple facilities to support patient and population health efforts. Large healthcare systems are working to improve care coordination, reduce duplicate testing in the referral process, and create a system to support improved patient outcomes.

Patient leakage—when a patient seeks or obtains services outside the hospital network—makes it difficult to track and support patient outcomes. The onus is on healthcare leaders to reduce patient leakage to support value-based care.

The Cost of Patient Leakage

Every year, more than a third of patients in the US are referred to a specialist. Healthcare executives report the following:

• 43% say they are losing 10% or more of annual revenue to patient leakage.
• 19% say they are losing up to 20% of revenues.
• 20% say they don’t understand where or why patient leakage occurs.
• 23% of organizations neither track nor quantify patient leakage.¹

Not only does patient leakage lead to lost revenue and increased coordination costs for the health system, it can also have negative impacts on the patient. With fragmented coordination outside of network, some specialists may not have full access to the patient’s medical records and history to support the referral.

One study found that approximately 70% of primary care providers (PCPs) reported sending patient history and reason for referral, but less than 35% of specialists report receiving that information.² Inefficiencies in the referral process can result in denied referrals, delays in patient diagnosis or care, duplicate testing, and reduced continuity of care.³

20% of malpractice claims for missed or delayed diagnoses involved communication deficits in handoffs.³

Patient leakage occurs for a variety of reasons, but it happens most frequently when physicians refer out-of-network. While relationships may be one cause of these referrals, one study found that 80% of out-of-network referrals in a 700-physician medical group were attributed to a lack of understanding of the Accountable Care Organization (ACO) network.⁴ Making it easier to find in-network care providers helps health systems provide coordinated patient care.

Patient Satisfaction Contributes to Patient Leakage

On one side, healthcare organizations can reduce business losses from out-of-network referrals and improve care outcomes by making it easier to find and hand off care to in-network care providers. The second side of patient leakage is when patients choose to leave the healthcare network, which could be due to a lack of information about in-network options or issues with patient satisfaction.

With patients now assuming greater financial responsibility for their care, and the consumerization of medicine in general, patients may walk away with a referral but then choose a competing facility. It sometimes happens because the patient is dissatisfied with their current care or simply because, through research or reviews, they choose a competing facility with little awareness of the impact the choice will have on the coordination of their care plan.

Optimize Communication to Reduce Patient Leakage

To reduce patient leakage, healthcare organizations need to support in-network referrals and help ensure the right information is communicated to the right care provider at the right time. A clinical communication and collaboration (CC&C) solution can help with:

• Unified Directory – Easily look up any member of the care team by name or by role. Referring physicians can look up a “cardiologist” to see a list of in-network cardiologists, with the opportunity to further refine the list by hospital or healthcare facility to best support patients.
• Safe Patient Handoff – Referring PCPs or hospital physicians can perform a safe handoff to seamlessly share patient history and clinical notes with the specialist.
• Coordinated Care – Support ongoing communication among the care team to foster team-based decision making and close the loop on the care plan.
• Patient Referral Follow-Up – After discharge or referral, an automated message can be sent to patients to connect them with an in-network provider (if not already specified) to schedule an appointment and help increase the completion rate of referrals.
• Patient Satisfaction Surveys – Surveys after each healthcare encounter can help organizations spot and potentially recover from dissatisfaction that can impact patient loyalty.

By focusing on reducing patient leakage, healthcare networks can help realize their value-based goals. To learn how to help support coordinated care and reduce leakage, contact us for a demo.

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