Out-of-network Referrals
When a doctor in your network refers a patient to a specialist, how often is that specialist in-network?
Every time your doctors refer patients out-of-network, or patients seek alternate providers, the unit price of care is increased.
Out-of-network referrals, also known as “network leakage,†can become expensive.
Estimates put the cost between $821,000 and $971,000 per physician.* For most organizations, the losses range between $200 and $500 million per year.**
Other indirect costs accrue as well:
Care becomes more fragmented. Without access to important information about the patient’s healthcare journey, outcomes can suffer.?
The success of risk-based arrangements is undermined since these programs rely on continuity across care settings and providers.
Patients are lost to competitors. Many health systems and disruptors like Amazon and CVS actively court patients and work to retain those that visit their physicians.
Network leakage sometimes is unavoidable. Networks may lack professionals able to provide required care and/or treatments. And the patient is the one who makes the ultimate decision.
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But other factors – which are preventable – are also at play, including:
- Weak or non-existent patient retention programs
- Physicians who may be unaware of the excellent specialists available in-network
- Lack of organizational focus on the issue
A place to start is to understand the scope and nature of the problem.
Data from insurance claims can create a window into patient journeys and providers’ referral habits. It shows patients' use of out-of-network specialists and other providers, plus hospitals, labs and urgent care.
HealthCorum’s proprietary referral identification technology uses data exclusively from insurance claims to track patient flow and communication between primary care and specialty providers.
Health systems, independent practices and ACOs can see which patients are accessing services, which services they are using, and develop a plan for mitigating wasteful care spend.?
Learn more: www.healthcorum.com