The Inner loop: Drive Volume by Keeping Patients Within Your Network and Physicians Satisfied

Editor's Notes

• #3: Maintaining your loyal customer-base can sometimes be a major challenge in our highly competitive aesthetic market. Your success depends on attracting and retaining patients, keeping them in-network.
• #4: Communication – Many times patients are referred to specialty care, present, and the receiving physician has no record, and no idea of why the patient presented. This creates both patient and physician sat issues When talking about the topic of physician referrals, Ian H. Leverton, MD, likes to tell the story of a patient whose general internist sent him to a gastroenterologist with a one-word note: “Abdomen?" Stymied, the gastroenterologist sent the patient back to the referring physician with a similarly curt note: "Abdomen present.“ Abandonment Rate: What is it? Your refer they don’t show! 46% of referrals go uncaptured or abandoned Source: Journal of General Internal Medicine Network Leakage: Physician referral rates have been steadily increasing but only 35-45% of referrals for adult inpatient care, as measured by revenue, go to a partner hospital. Hospital organizations need to maintain, capture and improve volumes in order to build revenue and remain competitive. HIMSS
• #5: Cumbersome paper processes such as faxing and copying documents, multiple phone calls and being placed on hold adds little value by tying up key resources and wasting valuable time. This is a major contributor to Patient and Provider dissatisfaction.
• #6: Womack J, Jones D. Lean Thinking. 2nd ed. New York: The Free Press; 2003. AAFP - Need to add comments as well as credits in footer… Why does this fail? No Left side – No follow up – all manual What is missed in the translation, refer back to 3 primary challenges and where they come into play This is where patient satisfaction and physician satisfaction take a hit
• #7: Barriers According to the 2014 Commonwealth Fund International Health Policy Survey of Older Adults age 65 and older, 86% waited between 1-3 weeks for a specialist appointment. The United States ranks last in this survey for specialty accessibility among persons over age 65. In the U.S., 35 percent reported at least one problem with care coordination, such as not having a recommended medical test, receiving conflicting information from different doctors, or experiencing a lack of communication between a primary care doctor and a specialist. When you have to wait, do you search for other options? Your time is valuable and time is money. [Next slide].
• #8: The stats tell the story 87 percent of Americans 65 and over experience at least one chronic disease 68% have 2 – this alone is a driver for care coordination 57% cannot get immediate access to care – part of this issue is the administrative issue of information share 35% have experience a delay in care due to administrative error. These are fully seen as a result of communication issue
• #9: Outside of a health care system. This occurs when physicians refer patients to a competitor hospital or provider, or when a patient chooses to see a physician/specialist outside of the system. By law, physicians are not allowed to conduct referrals based on their own personal financial gain. But from a system-wide perspective, shifting care out of network can yield higher cost lower quality and gaps in care. This is especially important for organizations participating in accountable care organizations (ACOs), since they are responsible for total patient and have a stake in the patient’s whole health vs. episodic care. 1) Hospital administrators assume that tighter physician-hospital integration (e.g., through employment of physicians) will result in “captive referrals” by physicians back to the mother-ship hospital. HIMSS need footer
• #10: Discuss how leakage was identified and the real cost associated.
• #11: Improving the feedback loop between referring and referred-to physicians. The coordination and tracking of patient care is a key component of care quality and, in turn, for risk-based payment eligibility. It also is required for patient medical care home certification. The need to improve communication is clear: One study estimated that the typical primary care physician coordinates care with 229 different specialists in 117 different specialty practices Need to add points to drive analytics and transfer
• #12: Improving the feedback loop between referring and referred-to physicians. The coordination and tracking of patient care is a key component of care quality and, in turn, for risk-based payment eligibility. It also is required for patient medical care home certification. The need to improve communication is clear: One study estimated that the typical primary care physician coordinates care with 229 different specialists in 117 different specialty practices Need to add points to drive analytics and transfer
• #13: Utilize technology to replace labor intensive Phone and Fax Process, This ensures communication with Patient, Provider, and receiving provider occurs. Tracking of both transfers and referrals Dashboards allow ease of use and a snapshot of current status, typically this is done in a log that relies on humans to update through multiple steps Ask about adding more branded slides
• #14: Transfer metrics such as receiving facility response time, transfer acceptance (in hours) and total transfer turn around times of area hospitals and departure to arrival are key indicators related to patient outcomes and transfer patterns. These indicators help drive decision, you cant get this from a book
• #15: Only by tracking referrals can an organization begin to understand and manage patient leakage. Targeted solutions can provide visibility into referral trends and standardize the referral process across the entire network, streamlining operations and communication with physicians.  According to data from HowsYourHealth.org, a health assessment Web site developed by Dartmouth Medical School, about 40 percent of Americans between the ages of 50 to 69 see more than one physician, and about one-quarter of those patients say they do not know who is managing their care. This makes referrals and consultations a pressing concern. Though you can't always control whether your patients see other doctors, you can do your part to make referrals and consultations more hassle-free.
• #16: Insert circle graphic to talk about information share – for referral and authorization – This allows for a clean process end to end, I can track the – All about WorkFlow
• #17: Every hospital incurs some level of leakage from their primary service area. Some of this leakage is expected, some of this is unexpected. It is in the unexpected where we hope to bring clarity to both direct and indirect referral relationships. Network Optimization   Identify opportunities to improve retention across service lines, providers and geographies Identify where patients are receiving care out-of-network Improve physician awareness with reporting tools Drive Volume
• #19: A healthy referral base and referral agreements are crucial in today’s competitive market. Retail markets are owning this space faster and driving patients to their brand much better than traditional health care organizations or physician practices. Why is that? It is because retail builds value upon convenience. More importantly, retail understands how to drive the consumer BACK to its brand. [Next slide] Referral pattern intelligence to drive optimization referral. Metrics to drive the patient into your facility and back into system. Use the tool and analytics to drive up volume and capture your network of providers that is asynchronous, closed loop communication with intelligence and keep your patients within your network and high profit service lines to mitigate any leakage of services outside your network.
• #20: YourCareUniverse is a solution focused on the consumerism and management of a patient, person or population across the most effective care venue. It will drive, manage and preserve the desired patient, person or population in our healthcare systems