Tools to reduce referral leakage in the medical group

Effective referral management is an essential component of medical group strategy, but many medical groups struggle to keep patients in-network. Often, medical groups have avoided adopting robust leakage solutions either because they assumed that employment and alignment would naturally influence referral patterns, or for fear of legal challenge. But with increasing ambulatory competition, medical groups can’t afford to maintain the status quo. Use this report and its accompanying tools to identify and operationalize your top opportunities to reduce referral leakage.

Download the Report

Not sure where to begin? The guidance in this report is organized into three sections:

To help medical group leaders implement the tactics outlined in the report, we’ve compiled a collection of member-developed and Advisory Board tools to jump-start leakage reduction at your organization.

Upgrade traditional referral practices (p.7)

Identify and prioritize leakage opportunities (p.13)

Streamline referral operations (p.19)

  • Common metrics used to rank physicians for referral
    Use this list to develop a data-driven process for referring to the right in-network sub-specialist. Commonly cited-metrics include patient insurance, convenience, and for groups in risk-based contracts, quality and cost.
  • Diagnostic: Selecting a model for referral management
    Use this diagnostic to choose which model—decentralization, centralization, or direct scheduling—will be easiest to implement for your group. Then, review the associated case studies to learn how medical groups implemented each model.
    • Decentralization: Successful decentralized models automate and standardized aspects of the referral process across practice sites, but maintain staff at individual sites. Learn how Brigham Health deployed a decentralized model. (p.28)
    • Centralization: This model removes referral coordinators from individual practice sites. See how Virtua Medical group provides a more consistent patient experience through centralization. (p.30)
      • Customer service training: Review how Virtua trains its access navigators on active listening, proactive outreach, and service to provide a best-in-class patient experience.
    • Direct Scheduling: This model uses a unified EHR system so that staff at one practice can see and schedule appointments at another practice, regardless of their specialty. Learn how CoxHealth successfully implemented direct scheduling. (p.32)
      • Direct scheduling workflow: See how CoxHealth mapped out a workflow for integrating direct scheduling capabilities into its EHR.
  • Sample job descriptions: referral coordinators
    Looking to hire the right staff for newly formed referral coordinator roles at your organization? Use these sample job descriptions to guide your efforts.
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