Patient leakage, also known as referral leakage, is when patients seek medical treatment outside of the health system network. Patient leakage may result from a physician referring to a provider outside of the health system network or by leaving the patient to navigate an overly complex referral process. This typically leads to loss of revenue for the health system and can affect the continuity of patient care.
Avoidable patient attrition accounts for between $200 to $500 million in revenue losses annually for many health systems. Much of this is due to a referral system that still relies on paper documents and faxing, along with leaving patients to self-manage their follow-up care. When patients are confused or unsure about a referral, they may choose to seek specialists elsewhere or simply give up after confronting too many barriers in our current fragmented health system.
When organizations prioritize strategies to improve attracting and retaining patients and orchestrating referral management, they experience an easier time repatriating them back into the health system network. One solution is providing targeted, personalized digital care, making it easier for patients to connect with network providers while transforming referral workflows to help increase profitability.
Healthcare leaders can prevent leakage and stand out among the competition by ensuring the following:
These areas are ripe for robotic process automation (RPA) tools that streamline practice operations, reduce overhead costs, and improve inbound and outbound care continuity coordination management.
High-volume and/or high-dollar surgical procedures for service lines such as orthopedics and cardiology are practical options where it makes financial sense to deploy RPA. For instance, virtual care platforms offering chatbots, consults, and online scheduling can supplement the care team’s interaction with a hybrid of in-person and remote support to manage the patient’s pre-and post-operative care journey.
As part of its enterprise digital transformation, Virtua Health, a large nonprofit community health system with multiple acute and non-acute facilities across southern New Jersey and Philadelphia, worked with QliqSOFT to launch a digital approach to referral leakage. Healthcare leaders created the “Cardiothoracic Pre-Operative Introduction” telehealth program.
This clinical case scenario illustrates how the digitally enabled program works:
Immediately following a cardiac catheterization with abnormalities warranting cardiothoracic surgical evaluation, patients speak with a cardiothoracic surgeon in real time via a complimentary audiovisual encounter. Staff can add family members or other caretakers to the encounter to hear the surgeon's feedback. This step also allows loved ones to assist the patient with medical decision-making on the next steps for surgery.
This cardiothoracic surgery virtual consultation service, which was identified as a need based on financial analysis data, has enabled Virtua Health to reduce leakage by about 20 to 25 cases per quarter.
With the national average cost for a single cardiovascular surgery ranging from $70,000 to $200,000, the payback from an organization's complimentary virtual visit/consultation can range from $1.4 million to $5 million in additional revenue per year just for cardiothoracic surgeries.
By understanding the effects of leakage and effectively using RPA tools, health systems can increase patient volumes and reduce financial losses, maximizing their capacity to provide in-network care access to people who need it the most.
Ready to learn how QliqSOFT can help your healthcare organization launch digital services to reduce patient leakage, drive referrals and so much more? Contact us today to discuss your challenges and allow us to craft a personalized solution for you.
Krishna Kurapati is the Founder and CEO of QliqSOFT. He has more than two decades of technology entrepreneurship experience. Kurapati started QliqSOFT with the strong desire to solve clinical collaboration and workflow challenges using artificial intelligence (AI)-powered digital technologies across the U.S. healthcare system.
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AllianceChicago, a national network of more than 70 community health centers (CHCs) across 19 states, today announced the publication of a quality improvement-focused article titled “CHEC-UP: A digital intervention to reduce disparities in well-child and immunization completion in community health” in Telehealth™ & Medicine Today. The project focus was made possible with the donation of QliqSOFT’s Quincy artificial intelligence (AI)-powered chatbots.