The lack of a formalized relationship management program between Pre-Access (acute scheduling, pre-authorization, and pre-registration) and referring providers can create access barriers and attract patient complaints. When those two parties don’t engage in proactive communication, the result can be poor perceptions of pre-access by referring providers, which in turn can negatively impact hospital referral volumes.
Physician office teams strive to advocate for patients, implement medically effective interventions and ensure each patient has equitable access to needed medical services. Community providers resist referring patients to medical service facilities when real or perceived access barriers such as inadequacies in care or gaps in pre-access services seem to exist. Therefore, it is crucial for pre-access to create a relationship management team specifically dedicated to removing those barriers. The relationship management team should work to understand what drives provider referral preferences and find opportunities to reduce referral leakage, provide a direct and responsive line of communication when access concerns arise, and proactively share necessary information to facilitate a trusting relationship to improve the patient experience and drive referrals to client facilities.
Below are three steps to begin removing barriers and building an effective and proactive communications strategy between pre-access and referring providers.
1. Choose and train the right people to manage physician relationships.
These are the people who will engage provider offices to create, maintain and strengthen relationships to improve patient access to hospital services to and encourage utilization of hospital services. They determine the cadence for rounding based on current referral volumes, perceived opportunities to increase utilization and provider office satisfaction with hospital access. They also identify and strategize opportunities to improve or educate provider offices on the referral process.
In addition to strong knowledge of pre-access products and services, a candidate should be well versed in service recovery techniques, know referral habits and able to identify trends via data analysis. Essential soft skills include the following:
- Excellent communication skills and the ability to listen and understand needs
- Driven to created needed change and does not accept the status quo
- Exuding professionalism and facilitating trusting relationships
Staffing needs varies by organization, but in general it’s important to take into account the extend of current barriers, community referral patterns, competition and volume of services currently being provided to the community.
2. Assess the current state.
Start by asking questions to frame the initial goals and success statement of the relationship management team, such as the following:
- What facility access pain points are experienced by referring providers? Conduct rounding in physician practices and ask whether they are experiencing challenges when referring. Ask follow-up questions to determine where barriers exist, e.g., scheduling, patient access, etc.
- How are pre-access services (e.g., provider self-scheduling portals, authorization services, and “schedistration”) being used in the market?
- In what ways is the competition better serving referring providers and patients? While rounding in physician practices, ask providers how the organization can improve to gain their business. Use a consultative approach to problem solving: Ask about the pain points, work to understand their needs and present solutions to address issues they’re experiencing.
- Is there an opportunity to improve perceptions of pre-access services? Set goals such as an increase in referrals from a specific practice, an increase in technology utilization or fewer complaints. Build a relationship with referring practices and follow through on initiatives for improvement discussed with those practices.
3. Plan and execute improvement strategies.
With the right people and information in place, the team can begin to identify and drive patient/pre-access improvement. At this stage, it’s essential to collaborate with the CFO, business development, physician chairs and other leaders including in EHR and IT.
Long-term success requires effective relationships and marketing. Consider the following to create a long-term relationship management strategy:
Drive system changes to improve referral experience and patient access to care. These changes could include working with leadership to consolidate how orders are received by the health system, promoting a standardized way to schedule appointments (e.g., one phone number versus four, or provider self-scheduling) and proposing system build changes to streamline scheduling and minimize patient delays.
Establish easy-to-use methods to track and trend data to show ROI and positive trending in key areas, such as reduction in access barriers, improved provider perceptions, decrease in escalated issues and gains in hospital referrals. Methods used to track and trend data include referral volumes by provider (reviewed bi-weekly) and trending feedback received from referring offices, reviewed monthly. It is essential to track trends on a continuous basis, identify new areas for improvement and strategize accordingly.
Create a communications plan to report impacts of program achievements to leadership. This report, occurring monthly, should include trending office feedback, process improvement projects and wins from the previous month.
|By Christel Tyree|
Revenue Cycle Liaison Manager
Ensemble Health Partners
These materials are for general informational purposes only. These materials do not, and are not intended to, constitute legal or compliance advice, and you should not act or refrain from acting based on any information provided in these materials. Please consult with your own legal counsel or compliance professional regards specific legal or compliance questions you have.