Top 5 Benefits of Utilizing a Care Navigation Partner to Schedule Appointments and Close Care Gaps

Every health plan has a customer service team to handle inquiries, and many have member outreach teams focusing on different tasks. Inbound or outbound, a regular part of the job involves helping members to find a provider and schedule appointments, often to close a care gap. 

So why would a health plan engage a care navigation partner like ReferWell to help schedule appointments? 

Health plan executives that I've talked with tell me that they struggle to ensure:

• Each member who needs it is outreached.
• Access to reporting on the outcomes of outreach and engagement.
• See data that shows what is happening with those members.
• Identify the clear impact of these efforts.
• Members are booked for the care they need.

Many executives focus on improving access and reducing time needed to get care. And we've been able to show them that 80 percent of the time, ReferWell schedules members in five minutes or less. 

I've captured the top reasons that our clients tell us they engaged ReferWell as their external care navigation partner to close care gaps and why it's been far more effective than trying to do it with their current solutions/programs.

Specialization and Focus 

ReferWell care navigators focus on scheduling and coordinating appointments for members. We're told that internal health plan care navigators typically have a broader range of responsibilities, including administrative tasks, member education, and other care coordination duties, so outbound calling and scheduling falls outside of their daily priorities. ReferWell care navigators can streamline the process and promptly allocate more time and attention to scheduling members by focusing solely on appointment scheduling.

Provider Relationships

ReferWell care navigators build deep relationships with healthcare providers and facilities while capturing a comprehensive dataset that can be searched in seconds to identify available providers by specialty, subspecialty, proximity to the member, and appointment availability… also seeing which practices are the most responsive and easy to work with. This allows ReferWell care navigators to quickly identify the most appropriate providers and available time slots for members, providing the best member experience with appointment scheduling. Internal health plan care navigators typically rely on a static list for provider information, creating additional work in calling multiple offices to find a fit and availability for the member.

Automation and Technology

ReferWell's proprietary technology and automation tools facilitate the provider identification and scheduling process. These tools can (and do) integrate with providers' electronic scheduling systems, allowing for faster provider search, real-time availability appointment booking, and automated updates. These technological advancements can significantly speed up the scheduling process. To date, the internal health plan teams we work with are still using manual processes (mainly 3-way calling), which is significantly more time-consuming and, at the end of the day, a terrible member experience (when was the last time you enjoyed waiting on the phone for 30 minutes while someone else tried to book an appointment for you?)

Efficiency through Experience

ReferWell care navigators have developed workflows and careful scripting to handle any scenario you can imagine. We have a playbook with over 250 scenarios and an ongoing learning process to continue enhancing these plays. We are familiar with the nuances of various healthcare systems, provider practices, and appointment scheduling requirements (which differ by office!). This depth of knowledge and skill helps us to navigate the appointment scheduling process quickly and effectively. 

A "Whatever it Takes" Approach to Scheduling Members

ReferWell care navigators have a clinical or social worker background and are empathetic towards members and their challenges in accessing care and how to overcome those challenges. This level of understanding, along with all of the efficiency, tools, experience, and focus, enable us to take care of all the tedious "back and forth" to get members to the visit and coordinate care among all stakeholders — the member, PCP, specialist, and the health plan. Our team is trained to go beyond what our systems provide and do whatever it takes to get the member the care they need. That includes assisting with PCP orders, confirming that the member showed up for the appointment, and verbally verifying that consult notes are returned to the PCP for care coordination.   

Of course, some health plans may have perfected the use of care navigators for member outreach and appointment scheduling to close care gaps. If you're one of the lucky ones — congratulations!

If you still struggle with any of the above-mentioned issues, consider adding a care navigation partner specializing in appointment scheduling. My experience has shown that it's not only the improvement in your HEDIS or STARs scores that have an impact. Your internal teams and your members will have a significant improvement in experience that will pay dividends when it comes to managing your quality program.