Leveraging the Referable Moment to Solve Key Challenges in Healthcare Delivery

Every one of us needs care at some point in our lives. And, we can all relate to the struggle of finding and scheduling what we need at a time and place that’s convenient for us. Unfortunately, it’s easy for patients, providers and healthcare leaders alike to name the usual obstacles—issues like outdated provider directories, knowing who takes the patient’s insurance and overly complicated appointment scheduling—and who the heck is making sure all the relevant information is moving from point a to point b?

As someone who has worked in healthcare technology for most of my adult life and, of course, been a patient, I know these care delivery challenges all too well. Like many of us, I thought deeply about what I wanted when it was time for my next career move. One thing I’ve held constant to as a baseline criterion is this: What I’m bringing to market must directly impact patients. And, that’s what landed me at ReferWell.

What we do at ReferWell changes the entire care experience for the better for both providers and patients, and I love that about our company. And, more broadly, when I think about how our team helps health plans and providers leverage the referable moment, I realize how we are solving key challenges in healthcare delivery so that the care experience just makes more sense. And with that, providers and patients don’t have to settle for complicated processes. When things are this easy, everyone gets time back and they can enjoy living their lives (and not feel like they need to be a special events coordinator just to get the care they need).

So, let’s break this down…there are several key challenges that patients, providers and plans must overcome when searching for, receiving and providing care.

First off, data is terrible. Simple questions like What cardiologists near me take my insurance and have open appointments? become a research project. At ReferWell, we collect, clean and curate the data and put it right in the workflow of physicians with search results that enable them to know the right doctor, their availability, if they take the patient’s insurance (in fact, we filter those who don’t out of the search) and even the equipment they have. Need to go for a treadmill stress test? We make sure that the cardiologist you need to see has that equipment at that location before offering it up as an option.

Next up, scheduling. When the patient is in the provider’s office (or on a virtual call, or on the other end of the phone getting test results and learning they need to get follow-up care), they’re ready and willing to schedule their next appointment. BUT the person they’re talking with doesn’t have the needed information at their fingertips to help. We make curated search results available to admins and providers based on the patient’s needs and then offer the schedules of the right providers who are in-network and geo-located near the patient.

Did you know that even when care is scheduled, patient show rates for Medicaid members hover around 30% (Medicare members are only slightly better, at just above 50%)? By leveraging the referable moment—the point in time when patients are ready to take action to improve their health—ReferWell increases patient follow through (show rate) with care by 60, 80, even 110% percent depending on the beneficiary population.

Okay, so now we have clean and clear data on doctors that is provided in a curated (filtered) search right at the point it’s needed, and you (the patient) have booked time with a cardiologist for your treadmill stress test before you left your primary care provider’s office. Yes, it IS possible and we’re doing it for thousands of patients daily!

But we’re not done yet. Another problem that has nagged healthcare since my early days building Health Information Exchanges (HIE) is that information remains siloed. Let’s go back to my original example of the colonoscopy from my blog post on why patients don’t follow up (which I did follow through with, by the way). If the providers involved had used ReferWell to manage my care, the PCP would have sent my medical history and the referral reason to the gastroenterologist so they would know what I needed and my background so no duplicate tests would have been ordered; the gastroenterologist would have sent clinical notes back to my PCP, and my PCP would know immediately that the appointment happened and the result. This level of care coordination is achievable and we’re already delivering it.

What I also learned during my HIE days is that just delivering technology does not magically solve problems. That’s why ReferWell is a technology-enabled service; we know that people need nudges and reminders to make sure things happen (we also have reminders that go to our patients, and that’s one other reason that our show rates are so much higher than anyone else).

And now that we have all of the data organized, we serve up the exact right physician and location, we’ve acquired the provider’s schedules and we’ve enabled (and delivered) communications and data sharing. In other words, we directly impact care delivery for the patient, the provider and the plan. And, (drumroll please) we can report on all of it! We know when patients don’t show, and we reach back out to them and the provider to help reschedule. We know which providers are responsive and who shares data back to the referring provider. We create aggregate reports and detailed reports. And, at a network level, leadership can see how many of their appointments are staying in- or out-of-network, how quickly appointments are being scheduled and how quickly the referral loop is closed and consult notes are sent back to close the loop.

ReferWell uses this all of this information to continually inform and improve our provider search—further enhancing the accuracy of the results, improving access, reducing the time it takes to get appointments and improving care coordination.

Now we’re getting somewhere … a better experience and improved patient care!

Some people like to say that healthcare is broken. I like to say it’s just a little sore from being overworked, because the “system” has been given a spoon to dig a hole for a swimming pool. But there is hope. Let’s bring in the enormous amount of knowledge from our own experiences as patients. And then let’s combine that with the efficiencies that digital tools provide and mix in the power of a little bit of manual help and system guidance to ensure things stay on track. Forget about that spoon, I’m talking about a backhoe that can dig 10 pools a day—all day, every day—with laser precision. We don’t even need AI; this is some fundamental work to relieve the sore muscles of the entire system and give capacity, accessibility and improved experience across the board.

I’d love to hear your thoughts and talk about how we can improve the care system. Let’s go fix this, together.