On December 3, 2020, Paul Deeringer, SVP Strategy & Emerging Business at John Muir Health (JMH), and Manisha Shetty Gulati, Clarify Health, led a boardroom discussion about the technology and strategy necessary to improve healthcare referral alignment. The boardroom was hosted by the Healthcare Executive Forum and brought together executives from hospitals and health systems across the US. The discussion topic is central to John Muir Health’s partnership with Clarify, and Deeringer shared his expertise gained from building JMH’s centralized referral service. Here is a recap of the conversation. 

Manisha Gulati (Clarify Health) and Paul Deeringer (John Muir Health)

What challenges are health systems encountering related to improving healthcare referral alignment?

Improving healthcare referral alignment is a high priority for all health systems, but they have varying methods for addressing this complex business issue. Protecting market share and preventing outmigration are key focus areas for improving patient volume. Investing in analytics to identify and minimize causes of patient outmigration is a more efficient and effective use of resources to maintain patient volumes than the more costly and challenging alternative of attempting to grow market share by identifying and capturing patient whitespace in the market or attracting entrenched patients from competing systems.

Other participants in the virtual boardroom pointed out the increasing importance of comprehensive, high-fidelity data in the face of the ongoing pandemic. One participant from a large California health system noted, “this has been a year of tremendous learning… in which we have had to tear up most of [our] playbooks and figure out how to serve our patients” in entirely new ways. The inability to be in-person has led to an increased reliance on improved data and reporting, as practitioners and administrators aren’t able to gather observational and anecdotal data while interacting with patients and other providers on-site.

Others in the boardroom emphasized the fact that many non-hospital sites of care are even further delayed in the transition to technology-based solutions. One participant pointed out that while most Skilled Nursing Facilities (SNFs) do track admissions and inbound referrals data, this monitoring and data tracking is done manually – on paper. Tracking information in this manner is certainly better than not tracking it at all, but trying to understand important information related to referrals and patient volumes without the ability to reliably track historical information over a period of months and years undoubtedly leads to significant clinical and administrative blind spots. These blind spots introduce biases and gaps that may significantly impact a hospital, SNF, IRF, or other entity’s ability to improve patient outcomes and ask the right questions about their role in a patient’s journey.

What technologies can health systems use to enhance their healthcare market intelligence and healthcare referral strategies?

As part of an initiative to establish a centralized referral services, John Muir Health took steps to provide their coordinators with regional referral lists. Rather than basing them on prior relations or anecdotal evidence, JMH partnered with Clarify to develop ranked provider lists for each region based on a physician’s:

• level of alignment with the health system (via an analysis of referral and rendering patterns)
• volume opportunity
• loyalist, splitter, or dissenter behavior
• DRG/CPT code level analysis

Through the partnership, Deeringer observed material improvements in the number of referrals sent to providers who were on their regional preferred lists, however, referrals were not flowing through the centralized service as planned. Next steps include addressing workflow challenges in a way that does not burden physicians.

Understanding the patient journey is critical for managing referrals.

Providers are beginning to think differently about managing patient volumes, particularly during the transition to a post-pandemic world. One method for improving the way a health system thinks about patient behavior is attempting to gain a comprehensive understanding of the full patient journey. The concept of the patient journey is one that has been discussed in healthcare for many years, but health systems are just now beginning to truly focus on their understanding of patients’ full continuum of care, especially the intermediate settings between major events, to optimize the way that patients flow in and out of their system, and ultimately, improve patient outcomes.

Another change in the way that some health systems may approach the uphill battle of improving patient volumes is to update the way in which they think about customer segmentation. Recalibrating the criteria when thinking about which patients to target for services, the varied needs of different patient cohorts, and the increased optionality in the site of care in both the near- and long-term will be critical to developing effective strategies to approach the market.

It may be time to reevaluate your provider referral strategy

Now, more than ever, systems need effective tools and methods to understand what is driving referral volume in-network referrals- and out-of-network referrals. Without realizing it, many organizations are using obsolete methods to track and manage referrals. Are your referral analytics obsolete? Download the guide to find out.

If you would like to learn more about the software products John Muir Health is using to improve referrals and drive patient volume, check out our Clarify Referrals webpage. Clarify Referrals prioritizes physicians for engagement and affiliation using the industry’s most precise referral logic and complete dataset.