Optimizing healthcare network referrals through “blended family” approach

By Christine Sasser-Perry

Vizient Associate Principal, Sg2 Patient Activation

Healthcare providers in many markets have found themselves becoming a part of something larger than they originally signed up for. For hospitals and health systems to be sustainable during current workforce challenges and margin pressures, they are increasingly joining large networks to drive revenue. As a result, the healthcare industry is seeing record numbers of mergers and acquisitions, often among competitors, and keeping physician referrals in network is key to their success.

When incorporating providers, it's important for systems to build relationships with the new organizations' specialized services to optimize network integrity — like a blended family. And because providers typically refer patients based on their relationships with other providers more than by their network affiliation, it's integral for the systems to welcome the specialists into the "new" family and culture. So how can systems grow their new family to become stronger, more efficient and provide a higher level of care to the communities they serve? The most successful approach for healthcare organizations to increase near-term revenue during and post-mergers regarding providers is focusing on three tactics: utilizing data, building relationships using outreach teams and implementing an organizational reporting structure that allows leadership to mitigate issues quickly, so providers feel heard.

Data is key

First, is understanding relationships between providers and organizations. Data is key to creating insights and actionable information. Using a claims-based tool provides that insight into those relationships, especially with providers new to a system. Strategic plans are then set in place to create new relationships with a focus on key service lines that will drive that desired revenue growth. Tracking the data also provides ongoing insight and ability to monitor those relationships over time. Research indicates that nearly 60% of provider referrals are going out of network, which can result in an annual loss of $200 to $500 million dollars for a typical health system.

Perfect conduit

For providers to be able to refer patients to in-network specialists, they need referral resources and an understanding of who the specialists are that they are sharing patients with. The best way to gain referrals is provider-to-provider introductions, which can be facilitated by an outreach team. Secondly, this team can serve as a liaison between provider interactions and facilitate continuum-wide communications through email updates and marketing collaterals targeted to new providers to the organization. Outreach professionals are not only the perfect conduit to execute building key relationships between physicians, but they also can help with orientation and provide support and a voice for the new providers.

Repositioning teams

During the pandemic many liaison teams within healthcare were significantly downsized or cut altogether. The time is now to reestablish these teams and empower them to do what they do best — increasing referrals, building, and maintaining that solid bond on behalf of the hospital or health system. It's also a great time for implementing training on best practice to reinvigorate old teams and jump-start new ones. Positioning liaison teams for success within the system through the support of hospital leadership allows for improved reporting, issue resolution and customer service for providers.

With these intentional strategies to build and foster closer relationships among providers and specialists, healthcare systems can strengthen their referral network management, which in turn provides immediate value for the organization as well as improved patient care.