In this video, Emily Roesing, Senior Director of Product at Clarify Health, discusses how to influence specialist referral and facility selection at the point of care.



I have spent many years focused on finding solutions that will help both payers and providers tackle this question:

How can we get patients to visit the best possible specialists and receive care at the right facilities?

Why is it hard to influence care selection? 

What it really comes back to is behavior and human decision making. At the end of the day, physicians are in their daily workflow visiting patients. So when they’re referring a patient to a specialist, they’re often relying on who they know, who they have relationships with, what the reputations of the health systems are. They’re not always able to look in the moment at what the cost implications are for the patient and what the latest data suggests about the quality of that care. And that’s a very human reality of providing healthcare to patients every day.

Similarly, when you’re thinking about why it’s hard to move facility selection for a physician, you have surgeons whose whole day-to-day jobs and job satisfaction will rely on how convenient it is for them to conduct 20 surgeries within a week. Which facility and how convenient that is, is the difference between them getting home at the end of the day to see their kids within a reasonable time, or avoiding spending hours on the road commuting between various outpatient and ASC locations.

What strategies are being used today to influence physician behavior? 

Take for example, the value-based care movement, the attempt to enroll primary care physicians in total cost of care arrangements and shared savings that rewards them for maintaining and quarterbacking improvements in healthcare on behalf of their patients. Take bundled payment, which rewards surgeons for better controlling the cost of an episode. The incentives are there, the strategies are there, and yet we’re still not convinced that offering macro incentives is actually trickling down into the day-to-day, influencing the decisions that are being made in the physician’s office at a given moment.

And so while those strategies and larger payment models are definitely part of the equation, I think there’s real opportunity to connect and plug the gaps with incentive programs and engagement strategies that bring real interventions into the physician’s office and the day-to-Day, offering physicians the data that they need, the incentives that they need as often possible.

What is an example of a successful physician incentive program?

An example of a set of orthopedic physicians who we’ve been working with over the course of several years by offering them insight into exactly which facilities they’re already using are most affordable for their patients, and providing frequent incentives, frequent performance data, and coaching and workflow support.

We have seen that physicians are able to move and increase the percent of patients who are using those facilities by 15% in their first year of participation compared to a control group who’s not enrolled.

And so I think it proves out that there’s real opportunity to bring behavioral elements and behavioral design.

What are some tips for designing a successful physician incentive program?

So thinking about how to give physicians insight into their performance compared to their peers, thinking about how to offer an incentive that’s linked to a discreet action, how to deliver data at the right time so that they and their staff feel rewarded and motivated. These are things that motivate all of us to do our jobs well.

And I feel very optimistically that if we can bring that into the practice, we will be able to tackle both of these areas of opportunity. Improving specialist care and who patients are seeing, and also helping physicians better tailor their facility selections.