The Role of Referral Management in Value-Based Health Care

The Role of Referral Management in Value-Based Health Care

Value-Based Care is a specialized care delivery model where healthcare providers are rewarded based on the health outcomes of their patients.

Under this model, providers are given financial incentives to improve patient health, minimize the effects and occurrence of chronic diseases. This encourages providers to help their patients live healthy lives in an evidence-based approach.

However, since the system relies so much on patient health outcomes, referrals can make it difficult for providers to acquire the revenue they deserve.

Despite providing primary care to patients, these providers might lose their fair share after referring patients to specialists.

So, unless a provider manages all referrals vigilantly, they can lose a significant portion of their earnings.

The only way to counter this problem is through an effective e-referral management solution. In this article, we will explain the role of referral management for value-based healthcare.

Benefits of Value-Based Care

Traditionally, fee-for-service (also known asa capitation) has been the primary source of revenue for healthcare providers in the US.

In this healthcare delivery model, primary care providers are directly paid based on the healthcare services they give to patients.

Value-based is a quality-based care model that benefits the community, patients, providers, and payers as a whole. It focuses on the quality of care given to patients and reduces costs for patients overall. Although the initial purpose of this method was to reduce excessive costs and spending and keep the cost of premiums in check, it can be detrimental for patients requiring advanced healthcare. These drawbacks include the following:

  • Irregularity in reporting models and lack of transparency in data
  • There is increased patient load, making healthcare practitioners responsible for wellness issues beyond their standard scope
  • The demands of a value-based system are higher than other systems, which makes it tougher for physicians

Why eReferral Management Solutions Are a Necessity for Value-Based Care Providers

An eReferral management solution is a system focused on tracking referrals and ensuring end-to-end referral management and communication.

It enables healthcare organizations to provide high-quality care to patients using a well-organized and customizable workflow.

The ultimate goal of eReferral management for healthcare is to enhance and streamline interactions among providers and maximize successful patient outcomes.

For more information, let’s read our case study on how Mackenzie Health transforms diagnostic image processes.

Role of eReferral Management Solution in Value-Based Care

In value-based care, healthcare providers need to face a wide array of challenges related to the referral process.

Inefficient referrals workflows coupled with poor communication, diminish the quality of care and harm patient experience.

Every year, health systems, on average, lose from 55% to 65%  of revenue to referral leakages. These losses disrupt the system’s efforts to invest in patient care and provide quality treatment to patients.

Providers often complain about inadequate patient information and reports, the lack of timeliness in the delivery of information.

All these factors contribute to patient dissatisfaction, poor care continuity, and ultimately,poor health outcomes.

A well-organized and automated eReferral management solution can transform referral workflows inn value-based care.

These systems enhance coordination between different health systems and play a critical role in ensuring improved health outcomes for patients.

eReferral management for healthcare can also enhance efficiency in existing workflows, cut down on overhead costs, minimize time spent on redundant tasks, and reduce wait times for patients.

Referral Management: 5 Reasons to Automate Your Healthcare Processes

The Importance of eReferral Management for Value-Based Healthcare Providers

The majority of challenges faced by health systems and specialists arise from a lack of coordination after a referral.

An eReferral management system acts as a bridge for communication and provides patients with a well-rounded and positive experience.

Using this technology, providers can track and manage referrals, communicate with a system with different EHRs, reduce no-shows, increase revenue, reduce operational cost, and ultimately ensure quality care in value-based models.

The Alberta Health Service found that two years after releasing its eReferral program, more than 65% of their clinical users found an improvement in quality of care.

Let’s consider a few more statistics:

An eReferral management can address these issues easily. With a referral management system, you can benefit from the following:

Addressing Referral Leakage

A referral management system minimizes referral leakage. This ensures that fewer people leave your healthcare system, preventing losses amounting to millions.

Reducing Lead Times

Operational efficiencies in the healthcare system force decision-makers to make compromises. Needlessly longer lead times are a nuisance for both, providers and patients. A referral management system can address this dilemma. For instance, primary care providers (PCPs) often refer patients to specialists, even when not required. Once you reduce waiting times, more patients will be treated, increasing satisfaction.

Expand Utilization

Tracking a patient’s progress is useful for improving utilization for both, staff and providers. It allows patients the ability to schedule their appointments based on their routines.

PCPs can use these systems to refer patients to the right specialist by going through directories and looking at providers, as per the quality, reviews, and other factors.

Increasing Patient Time

An eReferral management system can help you save time that otherwise goes into administrative processes. This way, more time is created for the thing that matters most: the medical visit. Taking out time-consuming and inefficient administrative processes and tasks ensures that patients spend maximum time with healthcare professionals. Improving the patient experience goes a long way in growing the healthcare practice and referrals will experience a noticeable rise.