Case Study: Specialist Referral Optimization

Optimize PCP-to-Specialist Referrals, Maximize Network Value

This case study is essential reading for health system executives seeking to enhance their PCP-to-specialist referral processes. It details how a regional health system with a large and growing provider network, including a Clinically Integrated Network (CIN) of over 2,000 providers, tackled the challenge of low in-network referral rates. By implementing a strategic referral scoring model and centralizing patient access, the system achieved significant improvements in network utilization, reduced leakage, and increased revenue. Learn how to optimize specialist scheduling, improve patient navigation, and strengthen provider alignment to drive better financial and operational outcomes.

Key Takeaways for Health System Executives:

• Reduce Network Leakage: Discover how to increase in-network referral completion rates (in this case, from under 40% to 88%) and keep patients within your system.  
• Improve Patient Access: Learn strategies to optimize specialist scheduling and reduce no-show rates (a 55% reduction in this case) to enhance patient satisfaction and provider efficiency.  
• Increase Revenue: See how effective referral management can drive downstream revenue growth and improve the average margin per specialist referral (a 19% increase in this case).  
• Strengthen Provider Alignment: Understand the importance of data-driven insights into referral patterns for better aligning PCPs and specialists within your network