As one of the largest physician-owned primary care groups in the U.S., with more than 450 providers across 80 practices serving more than 400,000 patients, Central Ohio Primary Care was dealing with a lack of connectivity and usable data with its fax- and phone-based referral intake system.

THE PROBLEM

After referrals were created in the electronic health record system and sent off, staff often could lose sight of the patient and their follow-up care.

"We did not have the ability to quickly obtain simple status updates on referrals through the scheduling process or even determine if they had been received on the specialist's end," said Ed Helvig, patient access manager at Central Ohio Primary Care.

"It wasn't until the first follow-up, usually around seven days later, that we would gain a bit of insight, sometimes calling the specialist only to find out then that they hadn't even received the referral at all.

"Other times our staff would be on hold for 10-15 minutes, would have to deal with cumbersome phone systems, or would end up leaving a voicemail, sometimes in the wrong person's voice mailbox, in hopes that the message would be received and replied to soon," he added.

Relying on manually faxed notes also was problematic and created extra work. The organization was losing five to 90 minutes per referral by using a fax- and phone-based manual referral-management system, with no way of capturing and analyzing data to report or identify what was working well and what needed to change in processes.

Staff had tens of thousands of open referrals in the EHR with limited context on where patients were in their journey.

PROPOSAL

Vendor LeadingReach offered the network of physicians the ability to communicate efficiently and effectively, regardless of the native software of each provider office, Helvig said.

"We could create a LinkedIn-like community connecting our referral partners to us to allow for the passage of critical information among providers that our EHR wasn't able to manage," he explained. 

"By leveraging their referral management technology and analytics tools, our staff would have the ability to easily track referrals, follow up with them in a timely manner, and ultimately close the loop on patients whose care needs were now handled by a referred provider.

"We also would be able to track performance across our locations to identify process bottlenecks or similar care coordination challenges," he added.

MEETING THE CHALLENGE

Instead of using a one-size-fits-all approach, LeadingReach proposed a tech-based referral system that was customized to fit Central Ohio Primary Care's specific workflow.

"As our initial approach to managing referrals was challenging, it was clear that working with a partner with expertise in the referral space would be a great benefit to staff and patients," Helvig said. "We have been able to successfully connect the network of providers digitally and create a streamlined referral process that has increased efficiency, improved patient outcomes and lowered cost of care.

"With the new streamlined referral-management process and software, PCPs, nearly 1,500 specialists, and care coordination teams in the COPC network have gained more insight and understanding into each patient's unique care plan to help the patient navigate to the next care setting and gained more time in their day to allot to other patients," he added.

With the reporting that staff now is able to do, the organization has optimized its provider network by diverting patients away from less efficient specialty practices and toward the ones best equipped to provide care.

"We now have insight into key performance metrics in real time, such as referral response rate, patient decline reasons, average length to schedule a patient, and the all-important referral-to-appointment ratio, which allows our PCPs to close the loop of care after a patient has been seen by a specialist," Helvig noted.

"With the LeadingReach Analytics platform, we are able to have robust reporting and remind specialists and PCPs of the operational efficiency level their offices should regularly demonstrate to increase our operational efficiency, improve speed of care, and subsequently improve the quality of care for our patients," he continued.

This personalized data delivered on a regular basis allows for care coordination teams to have more meaningful, data-driven conversations with staff and provider networks. With this new referral process and its proven efficiency outcomes, the organization's central referral center has taken on increasing responsibility, and is a valued part of the organization.

RESULTS

Central Ohio Primary Care has shifted away from fax-based referrals and now is digital, allowing staff to see measurable and improved metrics across performance and patient outcomes.

"Follow-up calls were replaced with digital messages sent through the platform, saving referral managers multitudes of time," Helvig reported. "Initially, the organization's referrals were 59% fax-based and 41% digital, but after 10 months, we were able to digitize 89% of all referrals.

"We now are able to manage six times the number of referrals monthly at the central referral center – all without hiring more staff," he continued. "This also has allowed PCP care teams the time and resources to focus on assisting more patients, and has helped in achieving a 100% increase in appointments for referred patients."

ADVICE FOR OTHERS

Don't get stuck in ways of the past, Helvig advised.

"Just consider the basic hurdles of traditional, and what some may call antiquated, referral management, all the barriers of a provider office getting data from specialists such as the lost faxes, the search time, the long hold times, voicemails that aren't returned," he said.

"Provider organizations are doing a disservice to their staff, but most especially their patients, by dragging their feet and not getting referral management under control," he concluded. "The transition to digital isn't hard and the ROI is monumental."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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