What does a good referral look like?
At its very core, a good referral is one that allows a patient to continue their care journey with providers who can provide high quality of care while staying in-network so that costs do not escalate. Referrals based on objective facts instead of word of mouth or personal recommendations about a provider’s performance can lead to better health outcomes. To achieve this, nurses and care coordinators in charge of finding providers need better visibility into care transitions so that they can guide their patients for their next treatment. Specifically, they need the following:
- Key performance metrics: Performance metrics that help determine the overall quality and cost of a provider can give a quick insight into their performance, whereas more detailed metrics into treatments relevant to the patient’s needs and procedures performed can provide more specific insights.
- Benchmarks: Benchmarks are important metrics that help contextualize and compare the performance of the provider against standards in the area. They help answer the question: How does this provider perform compared to a standard in a particular geographic area?
- Geographic information: Travelling long distances can deter patients from keeping their appointments. Knowing which locations a provider operates from can be important for care teams to ensure that their patients do not have to travel far to seek follow up care.
- Network Status: Knowing whether a provider is in-network can be critical in helping patients prevent higher costs of care.
In addition to these important features, nurses and care coordinators also need information that they can quickly get access to at the point of care, and that is easy to understand, reliable and most relevant for the specific patient. This will enable them to make faster and better referral decisions.
What are the challenges in making good referrals?
Through CareJourney’s extensive support to leading provider groups and health systems, we have unearthed the challenges faced by nurses and care coordinators in making referrals. To start with, they have to rely on their memory or anecdotal evidence to find and recommend the right provider. Spreadsheets containing this information can get outdated quickly and it isn’t easy to systematically capture information based on word of mouth. Even when they have determined a potential fit, they still have to call the provider’s office to seek the most updated information such as: are they in-network or accepting new patients? Which locations do they practice from? What treatments and procedures do they perform? Commonly, the best-fit providers are located too far from the patient or are not in-network, making it more likely that the patient will discontinue treatment.
Gathering all this information before each patient referral can be cumbersome and time consuming, disrupting daily work flows.