What if you could improve referral capture by 25%

Posted by Matt Berns Friday, May 27, 2016

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Referral capture is a critical factor for health plans and health systems alike. It has tremendous implications for population health as well. But what exactly does it entail? You can think of referral capture as ensuring the patient is referred to the desired provider.

Referral capture is a complex process with many moving parts. It is hard to do well. It is also difficult to measure.

So, how do leading health systems and health plans get it right? The trick is in scheduling the appointment and tracking attendance.

Consider the example of ED over-usage. Patients without a primary care physician often wind up at the emergency department when a healthcare need arises. It’s not enough to have an assigned PCP. Patients need to leave the ED with a scheduled referral appointment.  

EDs with this ability - to schedule patients with a referral appointment to a new PCP before the patient leaves the ED - see tremendous reductions in unnecessary admissions. In one instance, we have seen a healthcare system increase referral capture by over 25%.

This has huge implications for the bottom line: 

  • A 25% increase in referral capture led to an annual increase of 1,100 PCP new patient visits.
  • These 1,100 patients at minimum drove $150 of revenue per visit, although we have found the value of a new patient to a system to be much higher for some.
  • Reduction in ED visits led to substantial additional savings for the system through operational efficiencies
  • The total value per referral captured was estimated at ~$530.

From this, it is clear that a strong referral capture leads to a significant stream of revenue, which only becomes more dramatic as the size of a health system scales.

To learn more about improving referral capture, read our free report Convenience Drives Change.

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