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Hannah Drake By Hannah Drake • July 26, 2018

Referral Management Defined

What is referral management?

The definition of referral management is managing the process by which patients are transitioned to the next step in their care. This transition usually occurs at a critical moment for a patient: An escalation in care or a change in diagnosis. Normally referral management takes place in the context of a primary care provider sending a referral to a specialist, but also happens from specialist to specialist or from inpatient settings/emergency room discharge to a provider.

Why is referral management important to healthcare organizations?

Many organizations find that electronic medical records (EMRs) are insufficient for tracking and managing referrals. Patient referral management becomes particularly important when health systems:

  • Have referring providers who use different EMRs
  • Are coordinating care between employed and independent providers
  • Are managing one or several value-based plans
  • Are looking to improve patient access and the ability to schedule patients when patients need appointments
  • Are creating and managing a high-performance network of specialists

Taking a proactive approach to referral management allows health systems to reduce patient leakage, improve care coordination, and match patients to the care they need. Further, referral management software provides referral pattern insight that allows health systems to optimize provider networks for increased patient access leading to shorter patient wait times, better network utilization, happier patients and overall better patient care. 

What are the hurdles to making referral management work? 

Hurdle 1: Accurate Provider Directories

Maintaining an accurate - and therefore useful - provider directory is a long-standing challenge in the healthcare industry. It's not as simple as the accuracy of the name and location of a provider, although that in itself is challenge that many organizations face as they struggle to manage multiple sources of conflicting information.

To maintain accurate data, a provider database needs to reflect which offices a provider practices in, what types of insurances the provider accepts at which offices, whether the provider is taking new patients, and so on. par8o's patient referral software approaches this challenge from several angles - and we prioritize provider data integrity on a daily basis because we know that an accurate, up-to-date provider directory is one of the cornerstones of effective referral management.  

Learn About Our Referral Management Software

Hurdle 2: Care Coordination Between Doctor Offices

Care coordination between multiple offices is a challenge when they are using different EMRs. One benefit of using an EMR-agnostic referral management solution is that data can be shared between offices and allows staff to exchange files, patient notes, or simple information such as updated phone numbers or patient appointment preferences in a HIPAA-compliant manner without depending on fax machines or having to call the office, wait on hold, and leave a voicemail.

This change in itself streamlines the referral workflow for primary care office staff, specialty office staff, inpatient or emergency room discharge staff, and call center staff as it allows them to focus on the patients in the office and/or accomplish referral-related tasks more efficiently. 

Hurdle 3: Scheduling Appointments & Closing the ‘Clinical Loop’

The chance that a patient will attend a referral appointment greatly increases if he or she can schedule the appointment before leaving the referring provider’s office, so it is to a health system's advantage to make this process as seamless as possible. Because so many providers use different scheduling software, referral management systems need to be able to integrate with a range of scheduling systems in order to show available appointments when sending a referral.

Par8o further supports appointment attendance with patient engagement methods such as text messaging, and then encourages receiving offices to report appointment attendance outcomes and attach encounter notes to the referral in order to close the loop between referring providers and receiving providers.

Each of these steps - from the moment the referral is created, to the moment it is received and acted upon, to the moment it is scheduled, is monitored and reported upon so healthcare management teams can see and analyze real-time, actionable data about their patient traffic and network offices after a referral is made.


About the Author: Hannah Drake is par8o's Director of Marketing.