Get the patient to the right doctor, right away.

QueueLogix Partners with ReferWell

QueueLogix has partnered with ReferWell to create innovative solutions to the revenue cycle management challenges of patient referrals. In the new era of value-based care, clinical and administrative teams struggle with the patient referral process and the associated burden of follow up.

Each year, nearly 24 million Americans are referred to specialists and never complete the visit. The need for a significantly improved referral management process that reduces administrative hassles for providers, increases compliance and coordinates care between providers is a challenge the Referwell technology and QueueLogix’s LiveReferral solves.

Dr. Michael Murphy sat down with Vytas Kisielius, CEO of ReferWell to discuss the challenges of patient referrals and below is a piece of their conversation.

Dr. Murphy: Why is it that there have been so many attempts and shots on goal with referral management – and why does it seem to be so frustrating – and no one has been able to crack that code so far?

Vytas: It’s a problem that really doesn’t belong to anyone – any one of the players. Everyone has an interest in getting it solved better, but EMR systems don’t do referrals. They move medical records, and they keep medical records. Insurance companies deal with claims after the fact, and they wish they had an input into who gets referred where, but since they individually don’t represent the majority of any one doctor’s business, they have a hard time getting their way. Patients all too often are the recipients of the punt, right? So, the doctor says, it’s not my job to figure out where you should go, so here, you go figure it out. They might say, go see my friend Michael, or they might say, you need a cardiologist. Or they might even say here is a list of cardiologists, but that is rarely curated by who takes your insurance, who is the right kind of cardiologist for what you specifically need. So, patients end up in the wrong place, or no place all the time. Turns out that nationally, about 50% of the referrals never land in a visit. That is 24 million visits a year that are being missed when they should have happened at a specialist’s office.

Dr. Murphy: What is the financial impact if you are not managing your patients or referring them well? What is the potential? Do you have a case study or do you have something that is in your back pocket of what the financial downstream impact is for health systems that don’t manage their patients well?

Vytas: Sure. So, from the perspective of the healthcare system today, each year, 24 million patients who have referrals don’t complete the visit and that spirals out into all sorts of inappropriate care and care at other places then payers for this process would like to see. There is a study that says that it costs the industry an extra 150 billion dollars a year in unnecessary or too expensive treatments that could have been avoided if these patients had been sent to and gone to the referral specialists that they were supposed to go to. So, it’s a huge impact. If you think about it from the payer’s point of view – the person that is responsible ultimately for the total cost of care – you are losing the ability to direct the patient to the optimal outcome for themselves when they go off the reservation, if you will.

Dr. Murphy: So why do you think they are not completing the care. Do you think the patient doesn’t have the vested interest? Is it the lack of education, maybe? They felt better the next day? Why is it that they are not completing that level of care?

Vytas: Great question. There is a little bit of human nature baked into the process. When I’m not told where to go, and I haven’t agreed on a place to go when I leave my primary doctor or my ER, then its up to me to take the initiative. We know that, despite all the patient engagement movements that are going on right now, there are lots of instances where the patient either starts to feel better, or they are worried about what might happen if they go to find out how sick they really are, or just inertia, or they sort of start to feel like they can tough it out. All those things lead to the lack of follow through on the patient’s part. You have to remember it starts with the referring doctor in most cases, not closing the loop to begin with for the patient. So, they just say, you need to go see a cardiologist about that ticker, so if that’s the direction I’m getting, I kind of have permission to go or not go. Whereas if I have an appointment that my trusted primary has made for me, then I am much more likely to go. In fact, our studies are that its between 60 and 95 percent greater adherence when you can book the referral at the point of care. So, it makes a big difference in terms of the patient’s activity.

Dr. Murphy: What does this solution have that you think is a little bit different than the other companies that have come out before us?

Vytas: The problem that Dr. Bander ­– who founded the company and came up with this idea while he was in an ER rotation at a major metropolitan hospital – was these patients leaking out into the community when they left the ER.  Despite the direction that had been given to those patients, he figured if he could make it easier for the cardiology patients at least, because that was the practice he was going to do after that ER rotation. If he could get those patients directed to make it easier for them to come to him, that would be a win for building his practice and a win for the patients. In building this very simplified workflow that is internet based so it doesn’t require software, we’ve created a graphic interface that takes literally 90 second to make a referral happen instead of 12-15 minutes. By making it easier and by making it better for the patient, and at the same time increasing their compliance, it can literally be a win for the referring doctor, it can be a win for the patient, and when the compliance goes up, it’s a win for the specialist because they are seeing more people that were supposed to go to them that they never knew didn’t call and didn’t show up. So, we fashioned a very interesting win-win-win with a notion of a simple interface designed by doctors, for doctors to use.

The QueueLogix and ReferWell partnership is focused on providing a much-needed solution to health systems and providers who are losing hundreds of millions of dollars a year because of poor, siloed and ineffective processes between clinical and back-office teams. The partnered solution also seeks to ensure a more pleasant experience for patients who are too many times confused by the referral process.

QueueLogix and ReferWell’s Referral Management solution will also be available to combine the power of HealthChannels’ highly-skilled workforce (through sister companies ScribeAmerica and CareThrough). Achieving real-time results by replacing antiquated processes with next-generation software is a hallmark of QueueLogix platform capabilities. Combined with ReferWell’s easy to use system that gets patients to the right doctor, right away, QueueLogix is poised to transform care-coordination.