The HealthEC Blog

Health Plans, Mobile Applications and Closing the Referral Loop

In my last blog, I talked about the communication gaps between primary care providers and specialists when it comes to referrals, the need for healthcare IT vendors to close this referral loop, and HealthEC’s success in already doing so.

Now I want to shed some light on how combining mobile technologies with case management on the health plan side could further close the referral loop, drive population health management, and generate significant cost savings for payers.

First, a quick reminder on what we do to close the referral loop: our platform allows for information to be rendered to any clinician providing data on a patient and ensures that the primary care provider who initiated the referral gets all specialist information in order to do a comprehensive follow up. The solution accommodates closed loop referral management, wherein the appointment status is communicated back to the referring provider system. All cancelled, no-shows, not reached, denied and seen status is sent back to the provider. The progress notes, CCDA and any outcome of the appointment are sent back securely to the referred system.

At its core, we have technology in place that ensures patients receive an appointment with a specialist within two days of meeting with their PCP as well a PCP follow-up appointment within 10 days of their initial office visit to review specialist reports, labs, etc.

Now, when we bring new mobile applications and health plans into the equation, we have the opportunity to really turn the patient/provider/payer dynamic on its head. Mobile technologies are already used successfully by some providers to follow up with patients on things like appointments, medications and health monitoring, but health plans – which already monitor utilization, medical necessity, referrals and claims – are well positioned to invest in case management capabilities that could help close the referral loop and drive significant cost savings.

How?

If a certain amount of time passes between the approved referral and a claim not being filed by a specialist, health plans could follow up (by text or secure message) with both patients and PCPs. The same type of system could also be used for patients not picking up their prescribed medications or not showing up for lab tests.

So, while providers already have solutions in place that are closing the referral loop, health plans that incorporate these technologies into their systems could be real game changers in the healthcare space.

Sita Kapoor
Author: Sita Kapoor
Date of Publishing : 1/21/20 9:54 AM
Sita Kapoor is a data scientist and Chief Information Officer at HealthEC. She was recently recognized for her innovative work in population health management and thought leadership with Health Data Management’s 2018 Most Powerful Women in Healthcare IT Award.