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Impacting Referral Patterns with Insurance Plan Design and Provider Incentives

[fa icon="calendar'] Jun 1, 2017 11:04:00 AM / by Daniel Palestrant, MD posted in Referral Management, Deployment, Clinically Integrated Networks (CINs), Accountable Care Organizations (ACOs)

In my last blog post: When EMR integration Doesn’t Matter: Mechanics of Referral Management, I described how differences in the clinical setting -- namely the employment status of your providers (employed vs. affiliated) and EMR (single EMR or multiple EMRs) are the first two things you need to understand to impact referral patterns.

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When EMR integration Doesn’t Matter: Mechanics of Referral Management

[fa icon="calendar'] Apr 25, 2017 7:23:53 AM / by Daniel Palestrant, MD posted in Referral Management, Deployment, Clinically Integrated Networks (CINs), Accountable Care Organizations (ACOs), Employed Providers, Affiliated Providers, EMR Integration

Editor's note: This is part two of a four-part series. Read part one here.

Referrals are a particularly unique moment in a patient’s journey because there are many different parties involved, often with differing priorities. Emotions can run high.

For the patient, a referral occurs when the diagnosis has changed or the diagnosis requires an escalation in care. For providers, a referral can be an opportunity to best serve the patient by assisting them through the care transition. For patients, it can be a scary moment -- adjusting to new information about your own health. 

Add to that the different and often competing perspectives of the organizations the providers work for with the rules and/or preferences of the payers, and it is no small wonder that impacting referrals is not an easy task.

As long as the "governing bodies" have differing objectives, organizations will continue to invest in technologies and processes to improve referrals -- but a remarkable number of these efforts will fail.

In the discussion that follows during this blog post series, we will define the key steps in making sure your organization's referral management efforts succeed.

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How NOT to roll out a referral infrastructure: An analysis of the CareFirst BlueCross TCCI

[fa icon="calendar'] Apr 11, 2017 10:46:36 AM / by Daniel Palestrant, MD posted in Referral Management, Payers, Cost Savings

Among Blues plans, CareFirst is a giant among titans. As Chet Burrell, the company's CEO points out, CareFirst has a commanding market share in the mid-Atlantic states with a significant portion of the population and in fact a majority of supreme court judges counted among their members.

Since 2011, Chet and his team have spared no expense nor been shy about leveraging their dominant market position to roll out an ambitious cost and quality program. So an article in this month’s edition of Health Affairs showing little or no benefit to the effort is definitely raising some eyebrows.

The question is: What went wrong?

 

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Four Things: Why Billionaires Aren't Found in Waiting Rooms, Provider Directory Accuracy Leaves Room for Improvement, and More

[fa icon="calendar'] Apr 11, 2017 10:42:54 AM / by Hannah Drake posted in Referral Management, Four Things, Provider Directories, Patient Access

At par8o, we're into the sharing economy. That's why we decided to start sharing useful and interesting articles in the healthcare space that we normally share among ourselves. At times, this list will also include links to thought leadership on relevant topics by par8o's management team.

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Average time-to-appointment metrics have increased by 30% ...what is your healthcare system doing about it?

[fa icon="calendar'] Apr 11, 2017 10:39:38 AM / by Hannah Drake posted in Healthcare, Time To Appointment, Patient Access

Forbes recently published an article reporting that patients are now waiting an average of 24 days to see a specialist, as opposed to 18.5 days in 2014.

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