My story is a common one, and it highlights a pervasive challenge across the entire healthcare system.
I was speaking with my primary care physician (who happened to be virtual, and while that is super cool and the experience was fantastic, it’s not a key factor … or even a contributing factor here). I was having heartburn (or reflux, GERD or whatever you call it) and it had been going on for the better part of two years. I, like most guys, just ignored it. But I finally decided to talk to my doc about it and he did a great job of both educating me on what can cause this and setting up a plan to figure out the real cause.
Together, we built a high-level care plan. He explained that poor sleep can lead to GERD and that many people don’t even know they’re not sleeping well, so he recommended a sleep study. He also suggested an endoscopy (a scope of my throat) and because I was close enough to that magic age, he said I should get a colonoscopy while I was at it. He promised me that while both procedures would be done in the same appointment, they would look at my throat first and wouldn’t use the same device for both “ends.” (Thanks for the reassurance, doc!) And he sent me on my way.
Now, I don’t know about you, but it seems like every time I leave the doctor (virtual or in-person) I have something to follow up on or a next care setting to go to—and ALL of that effort falls to me.
Once the appointment ended, it was MY job to figure out:
- What physician do I see for each of these procedures?
- Which doctors are nearby?
- Who was a good doctor?
- Who took my insurance?
- Who accepted new patients?
- Who had availability?
- How do they get the order for the procedure?
And so on. This is the typical healthcare experience—the system expects the patient to manage all of this. My shoulders sank as I clicked off the virtual call. When was I going to find time to do all of that?
I said “the system” because it’s not anyone’s fault.
Not the PCP—The data they would need to manage my care is in multiple locations. It’s outdated and would require them to launch a scavenger hunt to find it.
It’s not the admin’s fault—Like the physician, they don’t have the data. Even if they did, they have no way of knowing if Dr. Jane’s GI group accepts my specific insurance and plan (let alone knowing Dr. Jane’s schedule).
It’s not the insurance company’s fault—All of that data is available, somewhere, on their portal. But how do doctors and members access it at the point of care, use it to choose the right physician and then schedule the appointment?
It’s not the specialist’s fault—They’d certainly welcome more referral appointments. At the same time, if the specialist hasn’t been selected and the order hasn’t been sent them, how do they know to reach out to me?
The bottom line is that the data is everywhere yet siloed. It’s not organized or even accurate (Who updates it, anyway?). Appointment scheduling is an insane burden because you need all of that data at your fingertips at the moment the patient receives the referral instructions (aka the referable momentSM).
So, how did I handle my doctor’s recommendation? I turned to my neighbor while having a beer with him and asked if he knew of any good GI’s in the area (my neighbor is a former Marine and now a firefighter), and what type of physician even does a sleep study? (It’s an ENT by the way, and no, I still haven’t done it!)
Leverage the Referable Moment to Schedule Referral Appointments
Now, imagine this scenario:
When my PCP tells me to go get an endoscopy, a colonoscopy and a sleep study he then says:
“And by the way, there are three GI groups within five miles of you, they all take your insurance and they all have appointments available. One is on Tuesday at 2pm, one is on Friday at 10 am and one is two weeks out on Thursday at 11 am. I can book this for you now and the system will send you a text with the location and time. You will get a follow up text one day and again two hours before your appointment. And, I can simply send all of the necessary documents over to the specialist with the appointment booking. Which one works for you?” (He does the same for my visit with the ENT.)
Maybe I’m out of town the next week so I take the Thursday appointment. We disconnect and I’m 100% prepared to take the next steps in my care.
Remember that list of things I needed to do to take care of this myself?
At ReferWell, we’ve made the ideal scenario described above a reality since 2015, and we do it at scale. We call that crucial point in time when everyone is ready to move care forward the referable moment. And by leveraging it, we are changing how healthcare is delivered, every day, through health plans and providers.
Those of us who work in healthcare are always trying to figure out how to get patients more involved with their care. That starts with reducing complexity, reducing patient burden and innovating to make things easier.
In the next post, we’ll outline the challenges in healthcare delivery that stop the ideal scenario from being reality. We’ll look at how solving issues like data accuracy, appointment scheduling, show rate, care coordination and reporting helps to streamline and integrate care delivery.
Written by Chad Baugh
Chad brings 20+ years of experience to ReferWell, coming from an extensive and successful background in healthcare and revenue management. He has worked at the leading edge of what's happening in healthcare including Health Information Exchange, Population Health, Value Based Care, Risk Contracting and Virtual Care. Chad oversees all revenue-generating activities such as sales, marketing, pricing and overall customer partnerships. As an innovative and progressive leader, Chad drives the success of ReferWell and it's overall business results.