NEW YORK, New York – May 22nd , 2018
Michael: Hello and welcome to Health Channel’s radio, I’m Dr. Michael Murphy, CEO of Heath Channels. We’re here with Vytas Kisielius, CEO of ReferWell, to discuss how we are tackling the challenges and issues of Referral Management. Vytas, it’s a pleasure to sit down and chat with you.
Vytas: Hey, thanks for having me. It’s great to be with you.
Michael: So, referral solutions, network integrity… it’s a huge topic out there. I think we have about 2,600 health systems that we work with across the country and in Australia and Canada. At the local level, they don’t really talk about referral solutions as much of keeping people in network, but with the system level – all the for-profit, all the big non-profits – this is their biggest challenge and the competition is surrounding them in. How do we keep people in network and build brand loyalty? It’s a huge administrative burden on the provider’s, it’s a huge administrative burden on the receiving institution, everybody’s using disparate systems and everybody says there’s been a lot of health systems out there or technology companies that have tried to tackle this. I’m excited because I think we’ve finally cracked the code a little bit so I’m excited to have you. I understand that you have been in Healthcare for a long time. Should we start there before we get into the solution?
Vytas: Yeah, well I am from a medical family, both my dad and my brother were Physicians. I was the black sheep of the family that decided to go to the business side, unlike you Michael, so I have to deal with that all the time.
Michael: I do miss clinical care, but I am happy to be on the corporate side as well, just making a bigger impact I feel. Why is it that there have been so many attempts, so many shots on goal with referral management and why does it seem to be so frustrating and no one has been able to crack that code, so far?
Vytas: Sure, so it’s a problem that really doesn’t belong to anyone of the players. Everyone has an interest in getting it solved better, but EMR systems don’t do referrals. They move medical records and they keep medical records. Insurance companies deal with claims after the fact and they wish they had an input into who gets referred where, but since they individually don’t represent the majority of any one doctor’s business, they have a hard time getting their way. And, patients all too often are the recipients of the punt, right? So, the doctor says it’s not my job to figure out where you should go, so here, you go figure it out. They might say, go see my friend Michael, or they might say, you need to see a cardiologist. Or, they might even say, here’s a list of cardiologists, but that’s rarely curated by who takes your insurance or who’s the right kind of cardiologist for what you specifically need, so patients end up in the wrong place, or no place, all the time. It turns out that, nationally, about 50% of referrals never land in a visit and that’s 24 million visits a year that are being missed when they should have happened at a specialist’s office.
Michael: I attend a lot of conferences throughout year. There is one coming up in New York in a couple weeks for the cities’ non-profits. Every health system there, and even at the for profit JPM Morgan conference, they’re tasked with managing populations more so than the nonprofit they’re taking so much more risk, there’s ACOs created with the insurance companies, etc. What is the financial impact if you’re not managing your patients or referring them well? What’s the potential? Do you have a case study or do you have something that is in your back pocket of what the financial downstream impact is for health systems that don’t manage their patients well?
Vytas: Sure, from the perspective of the Health Care system today, each year, 24 million patients who have referrals don’t complete the visit and that spirals out into all sorts of inappropriate care and care at other places than payers for this process would like to see. There’s a study that says this costs the industry an extra 150 billion dollars a year in unnecessary or too expensive treatments that could have been avoided if these patients had been sent to and had gone to the referral specialist that they were supposed to go to, so it’s a huge impact. If you think about it from the payer’s point of view, the person that’s responsible ultimately for the total cost of care, you’re losing the ability to direct a patient to the optimal outcome for themselves when they go off the reservation if you will.
Michael: So, why do you think they’re not completing that care? Do you think the patient doesn’t have the vested interest, is it the lack of education maybe, they felt better the next day, is that the doc doesn’t have a vested interest – why is that they are not completing that level of care?
Vytas: Great question. There is a little bit of human nature baked into the process. When I’m not told where to go and I haven’t agreed on a place to go when I leave my primary doctor or my ER, then it’s up to me to take the initiative. And, we know that, despite all the patient engagement movements going on right now, there are lots of instances where the patient starts to feel better; or they’re worried about what might happen if they go and find out how sick they really are, or just inertia; or they sort of start to feel like they can tough it out. All of those things lead to the lack of follow-through on the patient’s part. But, you have to remember it starts from the referring doctor in most cases not closing the loop with the patient to begin with – they just say you need to go see a cardiologist about that ticker and if that’s the direction I’m getting, I kind of permission to go or not go, whereas if I have an appointment that my trusted primary has made for me, then I’m much more likely to go. In fact, our studies show that it’s between 60% and 95% greater adherence when you can book the referral at the point of care, so it makes a big difference in terms of the patients activity.
Michael: Yeah I know, I just had a knee X-ray done. I had two surgeries on my knee and I had a follow-up to see what the joint space is and I didn’t even want to look at the X-ray. I was like I don’t want to know, I’m good. So, I can understand why some people don’t want to follow-up, they don’t want…the unknown is better than the known. The ER is tough because they’re discharging such high volume. They are just saying, hey just follow up with the cardiologists or whoever in a couple weeks. Same with the inpatient although I think they try to make more confirmed appointments out of the acute care setting on the inpatient side than the ED side (they’re both acute care). What is this solution that you think is a little bit different than the other companies that have come out before us?
Vytas: The problem that Dr. Bander, who founded the company and came up with this idea, saw – he was in an ER rotation in a Major Metropolitan Hospital and he saw these patients leaking out into the community when they left the ER despite the direction that had been given to those patients. He figured it could make it easier for the cardiology patients, at least, because that was the practice that he going to do after that ER rotation – if he could get those patients directed, to make it easy for them to come to him, that would be a win for building his practice and a win for the patients. In building this very simplified workflow that is internet based so doesn’t require software, we’ve created a graphic interface so it takes literally 90 seconds to make a referral happen instead of 12 to 15 minutes. By making it easier and by making it better for the patient, while at the same time increasing their compliance, it can literally be a win for the referring doctor and it can be a win for the patient. When the compliance goes up, it can be a win for the specialist because they’re seeing more people that were supposed to go to them that they never knew about – that didn’t call or didn’t show up. So, we fashioned a very interesting win-win-win with the notion of a simple interface design by doctors for doctor’s.
Michael: Who’s doing the point of care referral? Is it the doc, is it the nurse or who have you seen get the best results out of that?
Vytas: We’ve seen all of the above. It’s probably 90% of the time of someone who’s supporting the doctor administratively and 10% of our of our doctor clients actually say it’s easier to do the referral on ReferWell then to actually tell somebody what they want them to do. This plays right into the union that were talking about in our partnership here, which is having the scribe do it as an integral part of the encounter so that it just gets handled as opposed to the administrator who is supposed to deal with it later and they might or they might not do right away.
Michael: What are the results that you’ve seen in percent movement of populations with regards to keeping patients in network?
Vytas: In terms of in-network, we’re seeing in-network utilizations above 90%, which was below 65-70% before they started using something that directed the patients. When taken from their perspective of the health system, obviously that is a very large ROI. When you broaden it to a more populated health sense of the payer, whether that is a Medicare Advantage plan or Medicaid Managed plan, you can dramatically reduce the total cost per member when you can keep them not only within the network of participating doctors but optimize them to the top quintile of doctors for a given procedure.
Michael: There is one health system, I won’t mention the name, but a large health system in the Midwest and I was talking to the CFO and he said they’re current usage of discharge patients is about 62% they kept in-network. And he said if they got another 6%, if they kept 6% percent more of their patients in-network in their system and didn’t let them leak out to other networks – that’s 50 million dollars of downstream revenue for them for the year. It was based off of all the claim space data, so that’s what it was going off – it wasn’t based off pie in the sky kind of numbers, so that’s obviously a huge, huge ROI, obviously, if you can keep somebody there. It sounds like as well with this referral solution that you might be able to even build some brand loyalty within the health system for that patient.
Vytas: It’s an important thing to remember that the doctors today aren’t letting the patients leak out because they want to. It’s because they don’t think it’s a) their job or b) they don’t have the tools to really direct their patient to an in-network alternative. Our referral solution makes that dead simple for them by curating the list and providing doctors that have availability and that are the right subspecialty so we know that we were getting the referral to the right doctor and then making the appointment right then and there.
Michael: That’s awesome. We hear a lot about the changes in business practices with regulation and we’ve seen this big shift in the last couple years from…well, it’s still the bulk of things are still fee for service, but there is a big value based initiative moving into healthcare. Most providers that we see, and administrators, view this as time consuming and kind of an administrative drag, just another thing that holds them from keeping their head above water. Is there anything that ReferWell has that can assist providers or administrators in that kind of shift to value-based part of healthcare?
Vytas: One of the most important parts of value-based healthcare is closing the loop between the primary doctor and specialist so that that primary actually is in charge of the health of that patient, is motivated to be in charge and informed as to how to be able to give the patient the right advice. And, the problem is that if all the doctors are not on one EMR and they aren’t sharing one patient record it gets really difficult. It turns out that, nationally, about a third of the time the primary doctor finds out what happened to the referral after they sent it out, so they’ve always just seen as a black hole where they lose sight of that patient and they lose track of the thread of care. With ReferWell, we make it really easy for the specialist to close the loop and provide clinical data back even if they’re on a different EMR. You could have a whole network of doctors, some of whom are on different EMRs acting like they’re a single network that are working together to manage that on population’s care – it can have a big impact.
Michael: I was just at another conference here in Fort Lauderdale, EDPMA, and it was a great conference. There’s a lot to talk about some groups, ED groups, contracting with payers to go at-risk for patients; it’s a 30 day risk, managing those discharges to make sure they don’t come back. I also think there is a huge opportunity with lowering the cost of healthcare with Medicaid patients and we really need to rethink how we approach Medicaid patients in general to lowering the cost of healthcare. Do you see a scenario where the ED groups could use ReferWell, if they are going at risk, to make sure that when they do discharge the patient to their primary care or wherever it is, the clinic, that they can get that information back – the actual ED vs. the PCP?
Vytas: The ED serves as a PCP in that particular transaction. By being able to see the full loop of what happened to that patient – did they see the specialist; when did they see the specialist; did the specialist refer onward, if so to whom; what were the specialist’s notes back? By just even having all of that data comprehensively and in real time, two great things can happen. One, by having comprehensive data, they can now go the payers and say, look how well we are managing this whole set of transactions to the benefit of the cost of care and we think we should be provided the ability to benefit by being more efficient. The second good thing that happens is, if you’re part of the network and you have real-time visibility to all of these transactions as they’re happening, you can actually give providers feedback that will make them modify their behavior if they have the motivation to do so. If they have any financial stake in the at-risk portion of the payments, now it matters. Before it was just something where I let the patient go because it didn’t matter to me where they went so much and I couldn’t influence it, I thought. Now, I can influence and it matters, so it’s really important.
Michael: I was fortunate to talk on a panel at EDPMA and that was my biggest take home message – to be successful in emergency medicine in the next five years, definitely in the next 10 years, but really I think in the next 3-5 years – the emergency department needs to get out of the silo effect. They’re not just in the ED anymore and they really need to collaborate across the care continuum, whether that is taking risks, identifying chronic care management patients in the ED. There’s plenty of 65 year old people that don’t have a primary care physician. What do we do about Medicaid? What do we do about the postacute? It sounds like this solution definitely allows them to have a tool in their tool bag to be able to maybe even tackle some of those challenges, so that’s exciting.
Vytas: Well, I know that physician burnout is a big issue as well but there’s also admin burnout. As you mentioned earlier, more and more requirements are being put on people to keep track of and report on things. By combining forces, letting the scribes handle the referral, and having a system that tracks everything, you’ve just helped address not only physician burnout but also administrator burnout in a really effective the way that ends up benefiting the patient, it ends up benefiting the payer, and of course, the benefit to the providers. It’s kind of exciting.
Michael: Let’s just switch gears, we only have a couple minutes left, to talk about the integration with Health Channels and how our partnership is benefiting our mutual clients.
Vytas: Sure, the capability that we bring is going to be incorporated into your live suite as your LiveReferral. That means that any of your scribes will with then be able to immediately provide referrals for the institution that already serving without any big new integration or any big new implementation. The institution will just have to say, I want it, let’s turn it on. For QueueLogix clients that are using the live suite, same thing. This will be an integral part of that live suite. We also think there’s a CareThrough connection, because there are services that go along side the whole referral and transitional care that we are not as able to provide as you guys are positioned to provide. There’s a lot of opportunity to help clients there as well.
Michael: I think there’s a huge opportunity here. I’m excited about this partnership with the…we go to a lot of health systems and this is one of their big issues. Yes, they have provided burnout, they have challenges with efficiency or throughput or whatever the case may be. But the system level discussions are – we have X hospital system breathing down our neck and we have Y hospital system strategically buying people around us and we need to make sure we build some brand loyalty with our patients and keep them within our system and make sure they don’t leak out. I think that coupled with having a great medical scribe or the care team assistant, with this solution and some of the other solutions that we both offer, I think we can definitely provide a great opportunity for these health systems to take advantage of that.
Vytas: I think you’re right.
Michael: Well, Vytas, that’s all the time we have today. Before we go can you let the listeners know when they can go to get more information and learn more about ReferWell.
Michael: That’s right. Well, thanks again, I appreciate all the listeners that are listening. This is Dr. Michael Murphy with another episode of HealthChannel’s radio. Until next time, take care.