Intelligent Patient Referral Management: Everyone’s a Winner

By Bill Bunker, Executive Vice President, SCI Solutions

The fax machine may be celebrating its 90th birthday, but the healthcare industry has reason to shudder. Why? Too many medical practices rely on this outdated technology to send vital patient information from one doctor to another. Dissolving the medical community’s reliance on faxes extends beyond clerical benefits. It also acts as a catalyst for making smarter referral decisions overall.

Adapting Technology to Evolve with Patients’ Needs

As life expectancy increases, the need for long-term care and the capability to track multiple diagnoses for patients is critical. American males are now living to upwards of 76 years on average, while the average age of a first heart attack is 66. That leaves a decade of follow-up care, and not only with a cardiologist. Common comorbidities, such as COPD, depression, and renal dysfunction, may need to be addressed as well. So at this point your practice’s medical provider or referral coordinator, are juggling cardiology, psychiatry, and nephrology referrals. Organizing these in a way that is easy to discern is imperative to ensuring referrals do not fall through the cracks and the patient gets the best care possible.

Beyond the Fax Machine: Data-Driven Medical Referral Decisions Ahead!

The ability to select an ideal specialist is as important as keeping track of the various referrals a patient may have. Technological advancements in referral management help referring providers efficiently cater to patient’s individual needs, for example:

  • Does this doctor speak Spanish?
  • Is the office of Dr. X or Dr. Y closer for my patient?
  • Which doctors are contracted with my patient’s insurance so he gets the lowest out of pocket cost?

If a provider is geographically convenient, capable of accommodating certain requests, and costs less it follows logically that the patient would be more inclined to follow through with the appointment.

Emergency Room Efficacy is Necessary for Public Health

Gaps in the referral coordination system can result in detrimental outcomes for patients, physicians, and the community as a whole. Getting patients the treatment they need, particularly for chronic conditions, is not only imperative for overall health, but also is the most cost-effective option. A study by the New England Healthcare Institute showed a 20 percent decrease in emergency room visits upon implementation of a case management system in the area.

The overdependence on emergency rooms for non-urgent care or medical issues that could have been monitored and managed effectively with regular physician care can have significant economic consequences for communities. The American College of Emergency Physicians states almost 20 percent of patients seen in the ER have no insurance , and overall approximately half of emergency room visits go unpaid, so the hospital must absorb the cost. Therefore an underfunded emergency room is a potential crisis for everyone.

The Solution Starts with Referral Management

When healthcare systems look at something like care coordination they think of it as an appendage to what they do today, as opposed to a problem that can be addressed differently, and we’ve come to the table with a fundamentally different approach to managing referrals which will break the mold. The realm of healthcare is an ever-evolving machine. As our system and technological capabilities grow, we need to ensure we are following suit. Patients, physicians, and the community at large benefit, and optimizing referral management is an essential starting point.

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