Reducing leakage: Four places leadership can look to plug the holes

Leakage is the new health care buzzword, especially for those moving quickly into population health management.

Losing "control" of the patient can have tremendous impact on the continuity of care management, which can greatly affect your organization's bottom line.

Where does leakage happen? The most common source is referrals made between primary care physicians and specialists.

Referrals to specialists or other services are about as common in a physician's day as writing prescriptions. It goes without saying that most physicians' number one criterion in making referral choices is quality of care for their patient. There's the must have. Whether or not a provider is in-network rarely makes a difference. Instead, physicians tend to make referral decisions based on everything from patient choice, ease of access and wait times to personal preferences.

However, while it's the obvious place to look, leakage doesn't just happen in the physician's office.. To find the holes in your organization, you must first understand where and why leakage is happening. Below are four areas where leakage can occur. Consider prioritizing each area based on the greatest opportunity for improvement and your ability to track and trend results.

1. Employed Physicians. Most organizations begin to plug the holes by looking at their employed physicians. That's because it's relatively easy to set-up tracking systems to understand current referral patterns and quantify the number of referrals that are out-of-network. The results will tell you what's going on; the next step is to determine why it's happening. Use your physician relations field team to uncover the reasons. This valuable insight will help you uncover barriers that need to be removed, identify process improvements and address issues that need to be resolved.

2. Care Coordination. It's also important to identify the holes in your care coordination process, those missed opportunities where a patient was "in your hands" but lost during the care-continuum "handoff." Perhaps you can start by looking into the discharge processes across your organization. Understanding where your on-call physicians and hospitalists are sending referrals can help you find those holes. ED and/or IP discharges often require follow-up care that results in leakage. Another area to look at closely at is patient transfers, both into and out of your hospital, to determine where you're losing patients and how you can best retain them.

3. Ease of Use. Next, you have to ask yourself some tough questions: Are you exceeding your patient and physician expectations? Do you make it easy for physicians to use you? If you're falling short in either of these areas, it could be a big source of leakage. While there is nothing worse than realizing physicians find it difficult to work with your organization, it's an issue you have the control to fix. By focusing on overall access and service, you can improve both your physician and patient experience. After all, it's difficult for a physician to refer a patient to a specialist or service with a six-week wait time and just as hard for the patient to wait that long. The same can be said about service. Any physician who receives negative feedback from a patient about a referral will think twice before referring another patient.

4. Awareness. It's a poor excuse, but not knowing what you have can result in leakage, and it takes diligence to ensure that doesn't happen. Never assume your referral sources know what is and is not considered "in-network," and always communicate your expectations clearly to your employed physicians. You can also ask your field team to advise new physicians to the market, as well as office personnel who make referrals to imaging, rehab and other ancillary services. Because most referrals are based on personal connections, tap your field team to help build those relationships.

Reducing leakage is not about "forcing" in-network referrals. To plug those holes, you have to earn those referrals. In the end, you can't grow your business by being as good as the competition; you have to be better. Strive to understand what, why and how your referrals are happening. Then use that knowledge to change the conversation from leakage to "keepage."

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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