Primary care facilities, often the first point of contact for many patients, may be hampered by outdated and inefficient processes, but data analytics can provide a potential solution.
Primary care is an essential facet of modern healthcare, serving as the conduit through which many patients access and engage with available medical care services. When a patient has a non-emergency health concern, a primary care physician (PCP) is charged with evaluating them and providing guidance on diagnoses, treatments, and next steps. If the patient’s concern requires additional testing or expertise that a PCP doesn’t have, a referral to a specialist is often necessary.
Referral processes look different at every healthcare facility, but all of them rely on data sharing. In the past, patient information was collected and stored on paper, and shared via mail or fax. Some facilities still rely on these more traditional methods, which can cause significant inefficiencies and burdens for clinicians.
Other primary care facilities, such as Central Ohio Primary Care (COPC), have chosen to alleviate these issues by going digital. Ed Helvig, patient access manager at COPC, spoke to HealthITAnalytics about how the organization is using data analytics to streamline referrals and improve the primary care experience.
DATA ANALYTICS AND DIGITAL TRANSFORMATION
Digital transformation is a term that comes up often in conversations with health systems that want to become more efficient in utilizing the data they collect and in better serving patients. COPC is no different, according to Helvig.
The organization, headquartered in Westerville, Ohio, includes 500 providers across 85 practices that serve 450,000 patients in the area. COPC has expanded beyond the primary care office, with teams at hospitals across the region and a growing offering of ancillary services, but the focus remains on providing high-quality preventative and chronic care.
Meeting those goals requires effective data collection, management, and analytics. With COPC’s large patient base, reliance on traditional methods created barriers and waste throughout these processes, Helvig noted. Thus, the health system partnered with analytics company LeadingReach to accelerate its digital transformation and streamline key processes, such as referral management.
STREAMLINING THE REFERRAL PROCESS
Referrals are crucial for patient care, as they are the main method PCPs use to connect patients with a specialist when needed. Prior to EHRs and digital data sharing methods, providers, including COPC, had to rely on paper-based methods.
According to Helvig, a typical referral at COPC contains patient identifiers and contact information, like their name, date of birth, and phone number, in addition to referral-specific information, such as the name of the specialist or organization the patient is being referred to, the location of the specialist or organization, and the reason for referral. Necessary medical documentation, including past laboratory or exam results, is also passed along with the patient’s insurance information.
“Prior to implementing LeadingReach, we relied on the old unreliable fax method,” Helvig stated. “A week or so after referral submission, we would contact the specialist to see if our patient has been scheduled for an appointment, and often times, be told that they don't have our fax referral on file. So, this obviously created increased delays in patient care and unnecessary and costly duplication of effort. LeadingReach allows us to submit referrals digitally. Sometimes within minutes after submission, we receive an updated status from the specialist of either 'received' or 'accepted.'”
Because all referral data is fed through the analytics platform, COPC’s referral coordinators spend significantly less time performing follow-up as the process has been streamlined and specialist receipt confirmations eliminate the need for follow-up, Helvig continued.
Previously, following up required referral coordinators to spend much of their time calling specialists’ offices, being on hold, navigating complicated phone tree systems, and leaving voicemails that often went unreturned. By utilizing digital messaging and data analytics, these barriers have been mostly removed and referral coordinators can quickly follow-up on only those referrals that require it, Helvig stated.
“In the first 10 months of implementation, we were able to digitize nearly 90 percent of all of our referrals going out our door, a volume that is averaging around 6,000 referrals a month,” Helvig said. “So, to be able to have that electronic capability, and [have] peace of mind that we're not worrying that the specialist doesn't have a referral, or it's lost in transmission… [is] just a huge, huge win for really any PCP office.”
GENERATING INSIGHTS AND IMPROVING PCP-SPECIALIST COMMUNICATION
Not only has the addition of the analytics platform streamlined the referral process for COPC, but it has also helped the organization generate key insights and improve communication.
“[Prior to implementing LeadingReach], we were unable to obtain really the big picture view with our networks data, with referrals, which would help us make sense of the large volume and identify inefficiencies and bottlenecks within our own workflows,” Helvig noted. “We now have insight [in]to key statistics available in real time, such as referral response rate, patient decline reasons, average length to schedule an appointment, and the ever-important referral-to-appointment ratio, which allows us to close loops after a patient sees a specialist.”
In addition to these insights, the analytics platform allows COPC specialists to see reports on their performance during the referral process. This reminder of operational efficiencies, or lack thereof, often leads to conversations between Helvig and specialists’ offices about process improvement.
These conversations have been extended to referral sources outside of COPC as well, according to Helvig. Various specialist groups have been reaching out for conversations about how they and COPC can better collaborate and improve processes, so that patients receive high-quality, timely care a lower cost.
This improvement in PCP-specialist communication is a major success for COPC since starting the digital transformation process, considering that communication in healthcare is fundamentally broken, Helvig noted.
Because this communication pathway has been opened, it is significantly easier to monitor a referral and close the referral loop once the patient has seen the specialist, he continued.
Closing referral loops is just one component of effective care coordination and bridging care gaps, but it is critical for patients to move along the care continuum. Implementing data analytics is just one strategy to address these challenges, but experiences of organizations like COPC show that it can prove effective.