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This case study illustrates how a regional health system improved its PCP-to-specialist referral process to reduce network leakage and increase revenue. The system's challenges included low in-network referral success and inefficient scheduling practices. By implementing a referral scoring model to prioritize referrals, they achieved an 88% in-network referral completion rate, a 55% reduction in specialist office no-show rates, and a 19% increase in average margin per specialist referral. This case study highlights the importance of effective referral management for maximizing network value.

This case study examines how a large health system improved its ED referral process to increase service line revenue. The system faced challenges with low patient follow-up and leakage of referrals to outside providers. By focusing on key service lines like cardiology and implementing a program to navigate ED patients to in-network specialists, they achieved significant gains. The results included an 87% in-network referral completion rate and a $12.5 million annualized increase in service line margin. This demonstrates the value of optimizing ED referrals for improved financial performance and network integrity.

Stop referral leakage and keep more patients in-network with the strategies outlined in this article. It addresses the costly problem of primary care physicians referring patients outside of the health system for specialty care. The article details the three main points where leakage occurs and provides six tactics to address them. Key areas covered include optimizing EHRs for in-network referrals, centralizing referral management, and ensuring timely patient access to specialists. Health system executives and medical group leaders will find valuable insights to improve network integrity and maximize revenue.