Using Healthcare Analytics to Understand & Optimize Physician Referrals at the Point of Care

By Ming Zhang

August 12, 2021

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Background

In order to stay healthy, patients need to receive proper testing and follow-up care from other providers after seeing their Primary Care Provider (PCP). However, disruption between PCPs and referred specialists often threatens that care quality. Healthcare analytics can provide insight for primary care providers and specialists to identify areas in which they can improve referrals, reduce out-of-network leakage, and pinpoint referral opportunities.

Examine PCP to Specialist Referral Data

Which specialties are receiving the most referrals? And which individual specialists are receiving those referrals from primary care doctors? How are these specialists performing in terms of cost analysis and patient outcomes? Healthcare analytics can answer these important questions and help networks improve referral performance.

In the example below, we used CareJourney’s PCP referrals dashboard to identify primary care physician referral sources by specialty for a network in the DC metro area.

PCP Referrals by Specialty graph

The example above should inspire conversations about why so many referrals are being made out of network. Is the network lacking available specialists in these fields? Are the in-network specialists too busy to take on new patients? Further examination is needed to examine the reasons for this lost revenue.

Networks will also want to drill down on referral costs and outcomes in order to optimize financial performance and patient care.

The example below highlights the higher costs and poorer outcomes that often occur when patients are referred out of network – more than 200 patients are being referred to out-of-network specialists who deliver poor outcomes!

PCP Referrals by Provider Performance Index graph

Shared test results, better communications between PCPs and specialists, and a lack of follow-up are all concerns when a patient leaves his or her network for specialist care.

Spot and Prevent In-Network PCP Leakage

Network administrators will also want to address PCPs who consistently refer out-of-network to determine the doctors’ reasoning and recapture lost patients. In the example below, several physicians are referring 100% of their patients to out-of-network specialists. The success of a health network is dependent on understanding this data and taking action to prevent outside referrals.

Referrals Table -- Table Allowed Over Time table

Identify Referral Opportunities

Finally, referral data is an effective tool for identifying referral opportunities. For instance, health networks can find ways to grow revenue, reduce costs, and improve profit by including top referred specialists.

Referrals Table -- Table Allowed Over Time table

Facility referrals also represent another opportunity for healthcare networks to broaden their reach and offer patients more comprehensive care.

Top Facility Types Referred To In 2019 graph

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