True Care Coordination Begins with Referral Management

By Bill Bunker, Executive Vice President, SCI Solutions

In the age of instant electronic communication, why hasn’t the medical industry kept up the pace? Practices still rely on their antiquated fax machines to send and receive patient referrals, a contributing factor to why 50 percent of referrals never result in appointments. Better referral management is key to making healthcare available to patients in a timely fashion. Otherwise, the lack of continuous care can lead to worse outcomes for patients and the healthcare system, such as preventable emergency room readmissions. So where do we go from here?

Electronic Communication at the Core

True care coordination depends on shared medical information among a patient’s care team, including primary care physicians and specialists. By moving away from fax machines and towards electronic communication, we chip away at the barriers preventing us from providing higher quality care. Care coordination typically includes these five elements:

  1. Many participants are involved in care, (i.e. primary care provider and specialist)
  2. Participants depend on each other to carry out their individual care roles
  3. Participants are aware of other’s roles and how they interconnect with their own
  4. Participants rely on communication amongst each other
  5. All care services work together to ensure proper healthcare is delivered in the most effective and efficient manner

Consistent communication between medical professionals and its impact on quality care is evident in this cross-sectional study. Increased quality of care is much more likely when:

  • There are regular visits with a primary care physician
  • The same PCP makes appointments with specialists
  • The PCP sends information regarding the referral to the specialist
  • The specialist shares feedback with the PCP, including co-management plans

Could this sort of care coordination combined with preventative care result in better outcomes for patients? What about those nagging problems that can culminate in drastic emergency visits, which could have been avoided had the patient addressed the issue earlier? Perhaps the patient suffering from hypertension could have avoided a stroke had they received consistent care to manage his or her condition. In many cases, better care coordination could make a significant difference in patient outcomes.

Practice Makes Perfect

A study from Journal of the American Medical Association set out to test the effectiveness of coordinated care by:

  • Comparing two groups of urban adults with diabetes
  • One group had a high coordination of care, including a nurse case manager and a community health worker
  • The other group had a low coordination of care, including mail and telephone calls every six months as a reminder for screenings

They found that the group with a high coordination of care had fewer emergency room visits. Therefore, this consistent collaboration between medical professionals may have also avoided additional hospitalization costs. The more we can facilitate dialogue between medical professionals, the better our care will become. Revamping our technology will make communication more efficient, consequently creating an environment where care coordination is realistic and achievable.

A Method to this Madness?

Clear communication between patients, primary care physicians, and specialists provides a framework to improve the efficacy of preventative care and reduces the need for more expensive emergency care down the road. By implementing an electronic referral management system with a care coordination focus, we can improve patient outcomes. This is the golden ticket in moving towards more accessible, more affordable, and higher quality care for everyone.

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