How EHR-integrated referral management practices can lower specialty care costs

1 of the imperatives for achievements in the speedily evolving transfer to benefit-based mostly treatment and eventual threat is the productive management of referrals. A coherent referral management approach can assist to decreased fees by emphasizing the benefit of referrals, which alleviates 1 of the worries providers may have about their eventual transfer to a benefit-concentrated treatment model.

In a HIMSS20 electronic presentation, Mark Foulke, executive vice president, transformational benefit-based mostly treatment at Privia Overall health, highlighted the endeavours Privia is earning in supporting providers improved manage their referrals, irrespective of their setting up level on the highway to benefit-based mostly treatment.

Privia operates the Mid-Atlantic Accountable Care Group, an independent medical professional community encompassing one,one hundred-in addition providers, about 70% of them in main treatment and the remaining 30% training as specialists. Blended, these providers tend to roughly 590,000 sufferers.

The 1st phase towards obtaining improved referral management, mentioned Foulke, is to interact physicians in a shared vision.

“You have to have a payer you might be doing work with who understands the benefit you carry to the table, and they assist align values from that,” he mentioned.

1 way that this engagement can be fostered is by integrating referral management into physicians’ present workflows. By making the course of action into the digital wellbeing record, it turns into a purely natural ingredient of their working day-to-working day perform, and removes the want for them to toggle into and out of disparate packages — which can hinder their concentration and awareness.

According to Foulke, Privia’s technique functions due to the fact physicians effectively run the present them selves.

“The purpose the application functions is medical professional-to-medical professional governance,” he mentioned. “When it is a white-coat-to-white-coat discussion, it provides additional credibility. We produced a technique to have additional medical professional conversation and governance. You can apply that logic to your individual predicament. … Physicians choose who the referral patterns are likely to go to, and that generates buy-in.”

What Privia did was develop a price tag-effective, high-excellent subset of preferred physicians and amenities across all payers. This has improved the two the affected person and service provider encounter, and produced achievements in benefit-based mostly treatment arrangements even though also generating benefit for payers and specialists.

The way it functions is that physicians choose preferred specialists the specialists and amenities are tiered in the EHR and the preferred providers are evaluated, and high performers determined. The resulting preferred service provider group consists of only the optimum excellent, price tag-effective providers. That in convert prospects to decreased speciality treatment fees.

To illustrate the efficacy of the technique, Foulke pointed to 1 geographic area in which Privia operates that narrowed the referral community down to five specialties: cardiovascular, gastroenterology, ophthalmology, dermatology and orthopedics. The intention was to transform historic referral patterns.

In 2016, 30% of referrals in the area were likely to concentrated specialists. By 2019, that variety ticked up to just about 62%. Partly that was because of to narrowing down the variety of specialists in get to foster a additional concentrated referral sample when they get additional referrals, mentioned Foulke, that generates incentives to perform collaboratively on the benefit-based mostly treatment side of the equation. In all, there was a 23% increase in preferred professional referrals.

When main treatment providers determine which specialists to develop associations with, that drives referrals, mentioned Foulke.

“Physicians can be creatures of habit,” he mentioned. “If you will find a transform, we have to supply them with ongoing data. Quite a few occasions they could possibly refer out-of-community on intent if you will find a health-related want for that, but usually, providing data back to the providers can transform those people patterns.

“We totally believe that in the benefit of medical professional-to-medical professional conversation,” he mentioned. “We believe that in how significant physicians are to our lives.”

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