Over the summer we’ve been discussing the slight yet powerful nuance in the words ‘install’ versus ‘instill’ in relation to a referral coordination strategy within a high value network. Having worked for decades in healthcare technology, I can say this nuance pretty much applies to the success of any new operational change initiative. Why? The answer is simple. Regardless of industry and regardless of how much it may ease the staff’s workload or benefit the organization’s bottom line, introducing change to an established workflow will be met with resistance. It comes with being human. To move through the resistance, you need buy-in. You need your team to be willing to tolerate the temporary stress of learning something new because they believe it’ll be worth it.
In my previous posts, I’ve identified the three buckets of executive perspective about referral coordination in relation to value based care and outlined two of the three best practices I’ve discovered that support instilling (vs installing) a referral management initiative. The first – Explain the Why – has to do with educating your entire organization from executives and physicians to the front desk staff on why the co-management of patient referrals within a select group of community wide specialists is critical to both clinical and financial success. The second, Validate and Be Ready for Objections – covers the power of validation in overcoming change resistance. I’ve also outlined the four most common objections (and thoughtful responses) I’ve encountered while working with a variety of professionals across Independent Physician Associations, Accountable Care Organizations, and Clinically Integrated Networks on their referral management rollout. I’ll end the series today with the third best practice, Find Your Champion and Reward.
Risk Based Contracts Demand a Community Wide Care Team
Since the 90s, an entire profession has emerged around the concept of change management and there are few industries where it’s needed more than in healthcare. The drive toward risk based contracts is demanding a community wide team based approach to care; an approach that flies in the operational face of the current healthcare framework. With a reported 525,000 specialists in the U.S., the only way for any primary care physician to effectively track the quality and cost of each individual patient’s care is to narrow the field of specialists they refer to and ensure closed loop communications occur with each and every referral.
This is very different from the current referral process. If electronic referral management is part of a practice workflow it’s typically done via the EMR either as an electronic message (if the referral receiving entity is using the same EMR) or via eFax. And that’s it. It’s ‘one and done.’ There’s no central tracking mechanism to ensure the patient was accepted and seen by the specialist and/or way for the specialist and PCP to communicate electronically. The result is untrackable, one-off phone calls and fax requests for supporting documentation. And, oftentimes, it’s the patient (or the patient’s family member) who reports the results of their specialist visit to the PCP.
To sell the concept of following a referral from beginning to end to an executive or staff person who is already struggling to keep up with seemingly endless tasks is tough. This is when it’s imperative to implement one of the key principles of change management and find your champions. To do this, Mark Murphy, Founder of Leadership IQ suggests asking a variety of team members the following questions. The answers to these questions will typically lead you to your power players:
- Who do you turn to when you need advice?
- Who do you trust the most on your team?
- Who do you go to for answers?
I’ve known of at least one accountable care organization that not only focused on finding and rewarding their champions, they actually rewarded the entire organization by including all clinical (beyond physicians) and non-clinical staff with a percentage of shared savings. This significantly increased the motivation to implement, track, and report on referral outcomes. Other organizations have rewarded their non-physician staff with gift certificates, paid time off, and personal acknowledgment of how their contribution has impacted the overall goal.
Have you successfully rolled out a community wide referral initiative between your primary care physicians and specialists with disparate EMRs? What were the barriers you ran into and how did you overcome them? Email me at jfrancis@infinaconnect.com. I’m interested in learning more about what worked for you.
When Joe's not driving all aspects of business development at Infina Connect, he's hanging out at the beach with his wife and kids, surfing or flying airplanes. Joe is beyond passionate about changing healthcare and the impact referral coordination within high value networks can have on the patient experience, clinical outcomes, and affordability.