Healthcare is changing across the board—from medical advancements to operational technologies to the regulations that impact us all. Physicians looking to flourish must continuously evolve to keep up with these changes. One critical element that too often ends up on the sidelines is a physician’s status within their referral network.
Your current physician referral network is not the network of the future.
Don’t wait until you start noticing a decrease in referral patients – start taking action now to protect the future of your practice.
Why You Should Be Thinking about Your Physician Referral Network
Building and maintaining a strong referral network of primary care providers (PCPs) has not always been a top priority for specialists. Between keeping up with prior authorizations and managing increasing costs across a shrinking workforce, many feel that as long as their schedule is full, everything will continue to run as it should. Unfortunately, this is no longer the case. The healthcare overhaul experienced over the last few years means specialists must be ready to adjust to changing patient care flows. Waiting until the change is felt means it's already too late.
Building and strengthening your physician referral network is critical to maintaining practice independence.
It starts with understanding where you rank in the eyes of payers and then making yourself attractive to potential referral partners.
The inner workings of physician referral networks have changed. A circle of alumni, long-time friends, and mutual associations will no longer keep your practice thriving. Referrals have become less of a 1-to-1 decision and more of a many-to-1 decision, with referring providers, payers, and patients all having an impact.
Referring Providers
PCPs and other referring providers are under increasing pressure to refer to specific, high-quality specialists. Some have contracts with ACOs or other risk-bearing entities or are locked into value-based care (VBC) contracts that dictate who they should refer to. PCPs are increasingly aware of specialists' performance because these outcomes directly impact their performance in the programs they are participating in. Payers also encourage PCPs to refer their patients to specialists who they determine are "top performers" to ensure lower costs and better quality outcomes. Therefore, you must understand how each payer evaluates you.
Primary Care Providers are steered to specialists based on your practice's patient outcomes, satisfaction, costs, and utilization.
Like it or not, your scorecard impacts your access to a strong physician referral network.
Payers
Payers are looking for ways to provide high-quality care at a lower cost. They often have the most control in steering patients toward and away from certain specialty physicians. Payers control costs by narrowing network coverage or highlighting the physicians providing care that aligns with the outcomes and costs they are pushing for. That's why it's especially critical for specialists to stay on the "good" list—and in many cases, this means working within a set of parameters that may not be clear to them.
ACOs, Risk-Bearing Organizations, and More
Payers aren’t the only ones with significant influence over providers. ACOs and risk-bearing organizations also maintain contracts that influence where primary care providers are sending or keeping their patients.
Payers ultimately have many levers they can pull to steer patients toward certain specialists—and possibly away from you.
The chosen specialists are, therefore, those who consistently deliver the best care metrics to prove they provide high-quality care while meeting cost goals.
Patients
Provider referrals are often the starting point for patients, and while most patients trust their doctor's recommendations, increasing complexities around insurance coverage can lead many to research their referral options. Many patients turn to the internet to help them choose a specialist, and their expectations of a "good patient experience" are also centered on cost and quality of care. These expectations translate to medical expertise, which is the top reason for selecting referral specialists.
Patients largely trust the referrals they get from doctors, friends, and family.
However, 90% of patients still conduct additional research on at least some of the specialists they are referred to.
Value-Based Care Connects It All
It's important to remember that every patient is actually part of a value-based care program. Employers, payers, and primary care providers (PCPs) are participating in more complex risk-based contracts that monitor quality, cost, utilization, and satisfaction metrics, aligning with value-based care initiatives. With this in mind, specialists should recognize that they must proactively track their performance and leverage this data to strengthen relationships and maximize opportunities within their referral network.
Just because you aren't part of a value-based care program doesn't mean your referring provider or the referred patient isn't. Payers and providers are more likely to refer to specialists who meet value-based care goals.
The Obstacles of Physician Referral Networks
Specialists understand the value of physician referral networks within their practices, but many face the same challenges:
Selectivity
PCPs, other specialists, payers, ACOs, risk-bearing entities, and physician organizations are becoming more selective in who they refer to.
One study found that desire to refer within a practice or hospital system and affiliation with the practice were top factors in referral decisions.
Consolidation
The number of independent referring doctors is limited as more are absorbed into larger entities.
A number of studies have found that patient referrals are substantially altered by hospital acquisition of a physician practice and that these decisions are largely influenced by anti-competitive steering.
Priority
While specialists may already have a full schedule, focusing on referral networks that seem to be "working just fine" is not a top priority.
Approximately 80% of your referrals will come from 20% of your referral sources—so building the right network with the right providers is key.
Take a Proactive Approach to Physician Referral Networks
Traditional referral patterns have undergone a complete overhaul. It's no longer about who you know but how you rank and what story your scorecard tells. Specialty practices that don't adapt to meet these new standards will find their referrals slowly decreasing—and by the time that happens, it will be too late to fix it. Payers and providers will already have established strong networks with specialists who meet their needs and deliver the best outcomes and value.
Don't wait to find out how a payer grades you because it impacts your patient volume.
Take a proactive approach and start building out your network now.
How to Strengthen Your Physician Referral Network
Instead of letting others decide how your practice should be evaluated, take control and tell the story you want the decision-makers to hear.
Leverage advanced analytics that give relevant providers and payers the metrics that matter—instead of waiting for a scorecard to tell them.
Join—or create&emdash;clinically integrated networks (CINs) with other high-quality providers for thoughtful utilization that aligns with physician-defined clinical pathways.
Evaluate for continuous self-improvement—not just for your physician referral networks but for all of your practice operations.
TRIARQ Health: Your Partner for Strengthening Referral Networks
At TRIARQ, we focus on helping independent practices stay independent—building strong referral networks is a big part of that. As an independent physician, we understand that you're already dealing with many moving parts to keep your practice running while also prioritizing high-quality patient care. If you feel like you already have a full schedule and funds are flowing appropriately, it makes sense if your physician referral network is not among your top priorities. Today's network may be adequate—but, without attention, tomorrow's network may not be.
We're here to help you build and strengthen your referral network before it's too late.
How We Help
We support practices with a comprehensive approach to analyzing and maximizing practice opportunities—including improving physician referral networks.
Data-Backed Solutions
It starts by implementing the right technology to (1) measure the metrics that matter and (2) enable two-way data sharing. With these two critical data flows in place, you'll have a comprehensive understanding of practice operations and can share critical metrics with key referral stakeholders. Instead of waiting to be told how each payer rates you, you can evaluate your own outcome data and use that information to make continuous strategic improvements.
Clinically Integrated Network Engagement & Care Team Empowerment through QPathways
TRIARQ Health's secure collaborative platform supports true longitudinal clinical integration.
- Dynamic inter-organizational collaboration through chat, tasking, and escalations
- Flexible clinical pathways design supported by boundless connection to care teams
- Data integration to collect valuable data from all relevant sources
- Robust Data & Analytics through the monitoring of key metrics, including provider dashboards, economic estimates, and outcomes reporting
- Multi-modal engagement tools for patients and caregivers
The key to success is organizing care around physician-led clinical pathways and care plans.
Building Your Strategy
Your network-building strategy should focus on improving the operations metrics that matter in the eyes of payers and providers. Our expertise gives extra insight into the types of metrics that these stakeholders care about. Armed with this data, we work with you to establish the clinical pathways that maximize efficiency and revenue.
Referral Networks Are Just One Piece of the Independence Puzzle
With a dedicated focus on defending independent medical practices, we offer a range of services and technology specifically designed to serve the specialty market. We have the expertise to build custom solutions to help you optimize workflows, reduce denials, and meet cash flow budgets. In addition to helping you with your referral networks, we can help you to:
Don't Wait for Referrals to Slow Down
Strengthening your referral network is essential to staying independent, especially as value-based care drives change across the healthcare ecosystem. The main focus is not simply increasing patient flow but ensuring the long-term success of your practice. By leveraging advanced analytics, participating in clinically integrated networks, and continuously optimizing operations, you can take control of your practice's narrative and position yourself favorably with payers and providers.
At TRIARQ Health, we're committed to helping independent practices navigate these challenges, making them attractive to payors and referring providers, all while enabling sustainable growth for long-term success.
Want to know where you stand with providers and how the key components of your practice are impacting your referral network?
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