New Referral System Impacts Bronx Health Care

A primary care provider with an IPA in the Bronx sees a patient complaining of symptoms consistent with a gastrointestinal condition. As the doctor doesn’t feel equipped to diagnose or treat the problem, she refers the patient to a GI specialist.

“Only maybe the primary care doctor never explained to the specialist why she wanted this patient seen, or the patient may not be able to describe to the specialist his symptoms in the same way he explained them to his PCP. So, the specialist sends back a note that doesn’t answer the questions first raised by the primary care doctor, which means that nobody ends up solving the problem.”

“In the worst case scenario, the conditions worsen and the patient later ends up in the ED. All this may have been avoided if the PCP and specialist had been better connected and the patient had been communicated with more appropriately. And this is the type of scenario that happens all the time.”

This was how, over a year ago, Zoe Stopak-Behr, now the Director of Care Coordination Systems at SBH and then working in that capacity for Bronx Partners for Healthy Communities (BPHC), the SBH-led DSRIP Performing Provider System, described in basic terms the reasons behind the impending need to identify a solution to the inconvenient and disruptive information flow common to patient referrals between providers.

“We know that when providers are better connected to one another it helps them do their jobs better, it improves patient safety, and it enhances patient satisfaction,” continues Stopak-Behr. “Yet, we didn’t have an effective mechanism in place for moving patients efficiently between providers. Sometimes patients show up and nobody knows they are coming, or prior authorization isn’t in place so they can’t be seen that day, or the specialist doesn’t know the clinical context for the visit so they don’t know what questions they’re supposed to answer. Or, maybe, the consult report from the specialist is not making its way back to the referring provider.”

For these reasons, a search ensued to find a referral management software system that would meet those goals and optimize the referral process by minimizing disruptions in information flow and maximizing accuracy and accountability. After a rigorous search and vetting process, Stopak-Behr and her team selected ReferralMD, a cloud- based platform, to support SBH’s referral management services. Some of the winning features of this tool include functionality that:

• Effectively closes the loop on referrals by sending and receiving consult requests and reports and tracking the status of referrals;

• Integrates with EHRs so that providers never have to go outside their system;

• Provides front line staff with an easy-to-use tool to effectively manage referrals with reduced manual input;

• Offers built-in patient support to reduce patient “no shows” by sending referral information and appointment reminders to patients by text or email.

A Software Solution

“This platform allows you to search by different filters. So say you want a
provider who’s in a particular geographic area, who speaks Spanish and is female, and takes a certain type of insurance, you can do that,” says Stopak-Behr. “While it doesn’t go public, within your organization you can rate providers, or write notes about what your experience has been with them and you can see how things are moving back and forth between the sender and receiver. So, if I’m on the primary care side, and I put in an order for a referral to a cardiologist, I can go into ReferralMD and see if prior authorization is needed, or if certain tests are required prior to the visit, such as an EKG. An appointment time is then made, which gets sent back to the primary care provider, and later this provider can see whether the appointment was kept, with the notes from the consult. It tracks every step in the process, and there’s the ability to chat back and forth in real time.”

The official launch started in late 2018 with Doctors United, a small medical group in the Bronx that refers its patients exclusively to specialists at SBH, and so was considered a good case test. According to Dr. Jamie Santoro, director at Doctors United, the system has “fit the bill in helping us handle our compliance requirements. No one has fallen through the cracks and I haven’t heard anyone complaining. Our patients are getting appointments in a timely manner and our medical providers say it works.”

Today, in addition to SBH and Doctors United, Montefiore Medical Group, Acacia Network, Community Health Network, and community behavioral health groups from BPHC, including Jewish Board, Osborne Association,”
“Rising Ground and TRI Center, have gone live with ReferralMD, as has Bronx Park (which includes SBH physicians). Presently onboarding are Arthur Avenue Medical (which also includes SBH physicians), Union Community Health Center (UCHC) and ArchCare Senior Life. Discussions are underway with several other BPHC partners.

“We’re bringing on new referral partners, but for our mainstay providers that are referring, like UCHC, Bronx Park and Arthur Avenue, who together have been providing the bulk of our incoming referrals through CPRO (SBH’s Community Physician Referral Organization), we now have an electronic tracking system to manage those referrals,” says Irene Kaufmann, senior vice president of Population Health at SBH and executive director of BPHC. “Before, we never knew how many referrals we were getting or for what services, or how well we were responding to them. Now, we are in a better position to know this.”

An additional enhancement that was built to facilitate information flow between SBH and UCHC was an interface between ReferralMD and UCHC’s new EHR system, Athena. “The process before we created this interface was pretty cumbersome and forced CPRO to put in double entries,” say Kaufmann. “With this interface we can now offer UCHC a direct entry into the system which cut back CPRO’s processing time. This makes a big difference.”

Use of the referral system, less than a year later, has resulted in increased patient referrals for SBH specialists and greater efficiencies within CPRO.
According to Greg Erber, director of business development at SBH, which includes overseeing CPRO, the advent of the software tool has made a significant difference. “ReferralMD has provided us with timely information at our fingertips,” he says. “This has enabled us to better serve our providers and patients.”

ReferralMD helped SBH fill the gap for Montefiore several months ago when the large health care system lacked capacity for diagnostic mammography and needed to refer patients outside. Other FQHCs that traditionally referred only to Montefiore have begun sending their patients to SBH specialists. Word has spread both within the Bronx and outside. Recently, for example, a community health care collaborative from Austin, Texas, working with a similarly underserved, low income population, made a site visit to SBH to gain a better understanding of how the system works and whether it can be used to help them better integrate with their partners.

According to Kaufmann, the less obvious benefits of the referral system have to date far exceeded the more immediate tangible ones.

“It’s the business position that ReferralMD affords for SBH, how we’re connecting with providers in the south Bronx and elevating our profile,” says Kaufmann. “It gives us a bridge into the community. This is not how people looked at us before, and that’s made a big change for us. They see that we have cutting edge processes in place now that have created an experience around the referral process that provides an integrated system with greater reliability, better tracking, and improved accuracy.”