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    Why can't all patients see referral cost, quality, and availability?

    By Sonali Duggal • May 10, 2018
    Doctor Shrug

    Last week, David Shaywitz tweeted about an experience booking an imaging request while he was with his PCP at One Medical:

    Sorry, one more on total lack of transparency in HC. I'm at my @onemedical PCP yesterday, we decide on an imagining study I need, he is able to pull up a list of facilities, and what insurances they cover, but: 0 info on cost, 0 info on quality, 0 info on speed. This is nuts. 

    - David Shaywitz (@DShaywitz), May 4, 2018

    This is par8o’s raison d’etre: Making the best decision for the patient by making data visible and actionable at the moment of the referral. Here’s our take on turning this into reality:

    Cost to the Patient

    To David’s point, and the subsequent Twitter conversation, ideally we would be able to pull his specific plan details for the imaging study requested via an integration with the payer, and - right in our referral management platform - display how that cost might vary among local imaging centers, both in-network and out-of-network. 

    In theory, this is a great idea. In practice, no health plan has even the smallest incentive to allow this information out of its system in an easily digestible way. If you think that integrations with EHRs are hard, integrating with health plans is essentially a lost cause. We’ve tried.

    Provider Quality

    Quality can mean lots of things, but here we think quality describes both the patient’s and the referring provider’s experience with a particular facility or specialist. Our referral management solution incorporates patient text messaging as part of the referral process: we send a text message to patients after a scheduled appointment and ask them to rate their overall experience.

    This patient satisfaction rating is then pulled back into the provider ranking algorithm used to populate our recommend providers list, which referring offices see when making a referral, and is one of many factors involved in which care providers we recommend to referring office staff.

    We also allow referring providers and staff to rate their experience with the facility or specialist. This makes quality into a metric that’s dynamic and relevant to both the patient and the referring provider.  

    Speed - a.k.a. Appointment Availability and Patient Access

    Yes, referring providers (and support staff) should be able to access information about how soon a patient can be seen for consult. But it's not just about appointment availability - even more importantly, referring providers and supporting clinical staff should be able to tell whether or not a patient could be seen within the clinical urgency deemed necessary by the primary care provider or internal medicine doctor as related to the patient's condition when making a referral

    This information alone would have a positive downstream multiplier effect on patient access, as specialist staff would know which free appointment slots to give to which consults; patient experience, as patients with more pressing needs would be seen sooner; and patient outcomes.

    One of our clients, CityMD, circumvents this patient access issue by instructing referral staff to call recommended specialist offices for all referrals marked "stat" to schedule a same-day appointment for the patient before finalizing the referral - and before the patient leaves the clinic. But not all organizations have the support staff, nor the time, to make phone calls to multiple offices trying to schedule an appointment for a patient.

    Sometimes, we can incorporate direct scheduling into our referral management system by way of real-time bi-directional integration with each specialist’s or facility's scheduling system. The staff person can then schedule the appointment at the specialist's office on the spot. However in most cases, specialists and facilities don’t want to provide access to appointment availability because they are hesitant to cede control of their schedules. This is a political issue more than a technical one.  

    As we tweeted, in our ideal world, ancillary services/specialists would compete with each other to provide the lowest cost. highest quality, and fastest service, and all of that information would be visible to referring offices and therefore actionable at the moment of the referral.

    We're in the trenches getting there.

    About the Author: Sonali Duggal is par8o's SVP of Business Development and has held leadership positions at Medtronic and the Clinton Foundation.

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