Network Leakage: The Cause & Effect

Technology has the opportunity to create seamless communication for healthcare organizations, providing a secure and efficient method for ensuring patient, staff and provider satisfaction. It can enable better collaboration for healthcare providers and improves care coordination and delivery. But what happens when technology, such as EHRs, do not communicate with one another?

The value in technology is negated when systems are unable to communicate effectively. Accountable Care Organizations (ACOs), often made up of many practices using different EHRs, struggle with network leakage because of the disparities.

Where does referral leakage rank on your priority list? Too often, it doesn’t hit the priority list until an issue with out-of-network referrals is brought to light. It’s inevitable that some referrals will be sent out-of-network due to preference, location or gaps in specialities. But you first must understand why referrals are leaving your preferred network to determine if it’s a healthy balance.

The Cause

A simple yet complex issue is knowing who is actually in-network. Your preferred network of providers could include hundreds of specialists with many sub-specialities that are being underutilized because your practices aren’t given a good way to manage their list of referral partners.

Referral recipients are often based on a prior relationship or a quick speciality search. Equipping your network with accurate, up to date visibility to in-network providers, specialists and services will improve utilization of your most valuable resources and improve appointment timeliness.

Technology barriers created by multiple EHR systems make it difficult to send and receive referrals but most difficult to track the referral status, making coordinating patient care challenging.

An EHR is typically one of the largest technology investments and the source of truth for patient information. Utilizing tools that work in conjunction with individual EHRs allow ACOs to operate efficiently and without implementing one common electronic health record platform network-wide.

The Effect

Uncoordinated patient care is often a result of patients being referred outside of a preferred network of providers. An ACO has the ability to set standards for patient referrals such as:

• Referral must be made on a single system wide referral form
• Types of notes and data required to support each referral request
• Appointments must be set and communicated to patients within XX days/hours
• Consult reports must be shared within xx hours/days of a patient visit

These standards will ensure closed loop communication and better-coordinated patient care between primary care and specialists. Patients are less likely to become frustrated by delays in care or lack of communication when standards are in place.

Out-of-network leakage can create major financial burdens on ACOs over time. Depending on the ACO and size, patient referrals being sent out to out-of-network providers can equate to millions of dollars. The success of an ACO’s physician network is dependent on incoming revenue, patient satisfaction and providers improving care delivery.

The upside is that within a few months, revenue can greatly increase if the appropriate steps are taken to decrease referrals sent outside of your preferred provider network.

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