How Providers Refer
Modern research reveals a harmful paradox
Care providers in the US endure an onslaught of metrics aiming to measure their personability, quality, and appropriateness of care, however, the caliber of their referrals and the systematic measurement of their referral outcomes, remain in a largely untamed, pseudo-scientific space.
The Big Shift
US healthcare has become increasingly specialized and value-based, and despite consolidation, many patient journeys are more fragmented than ever. As a result, care orchestration has become incredibly complex, prone to missteps and blind to nearly half of all referral outcomes.
The unfortunate outcome is that provider referral patterns, within their natural state, have become a liability to the quality and outcomes of patient care. At the heart of this issue is a paradox that creates a fundamental friction between the modus operandi of providers and the evolution of healthcare systemization.
The Referral Paradox
Provider referrals are fundamentally relationship-based human interactions, yet hyper-specialization and large-scale healthcare consolidation has required most providers to maintain, albeit untenably, hundreds of referral relationships simultaneously.
Providers Are Relational
A study done by Kierkegaard and Owen-Smith (2020) suggest that providers make referral decisions like, well, human beings. Providers routinely make these social decisions just like the rest of us: based on shared experiences, personal similarities, community ties and word-of-mouth reputations. Outcomes, care quality, cost and availability are not necessarily top of mind for providers when making a referral - which shouldn’t be surprising to us when we consider the humanity of providers, the burden of managing complex care journeys, and the sheer volume of referral relationships required to do so.
Notwithstanding, Barnett, Michael L et al. (2020) add dimensionality to our understanding of the referral choice architecture, revealing that despite valuing relationships over metrics, providers’ main priority remains the “medical skill” of the referred providers.
Fundamentally, this implies that providers value quality and outcomes, however, they trust in a different set of metrics. Their measures of quality are in the currency of relational trust. This is often overlooked when assessing provider behavior but it is critical to understanding “why” providers refer.
Care Landscape Entropy
Today, US Healthcare is characterized by a growth in patient choice, a ballooning number of specialists, and a wholesale decline in primary care management of care journeys. Over ⅓ of all encounters now require a specialist, yet providers in the increasingly decentralized care model are expected to maintain more than 100+ referral relationships.
Consequences: Providers and Patients Suffer
Robin Dunbar, the famous evolutionary psychologist, suggests that humans can only effectively maintain 50 close relationships at any given time. However, trends of US healthcare have pushed providers in a direction that requires them to manage often double that number of relationships - leading to decision burden for providers and a decline in the quality of patient journeys.
Unfortunately, the creation of a non-human-centered system of health has resulted in a 45% referral communication rate, a 19% mis-referral rate and a 50% self-referral rate, indicating a breakdown in care coordination and a tipping point in the relational capacity of provider’s referral networks.
Solution: The Care Milieu
In the face of growing healthcare complexity, Fajardo-Ortiz, Fernández-Ortega et al. (2020) suggest the need for an application of behavioral economics, social network science, and topological data strategies that result in tactful, intentional nudges to improve the human-centered system of health for all.
Fortunately, that’s exactly what we do at Monocle Insights. Our product suite is centered around the Care Milieu, which takes the relational aspect of health to its ultimate end, by placing 1B+ healthcare claims annually into an intimate (though massive) social network. Such optics give health systems a holistic view of entire patient journeys that pass through any one of their employed providers.
Atop the Care Milieu sits an entire set of machine learning algorithms that deliver relationship-specific feedback loops within every provider’s referral network and behaviors, identifying important metrics such as: recoverable network leakage, procedure-level care gaps and relationship-sensitive referral recommendations, to name a few.
An evolution of healthcare that is inattentive to the humanity of care providers, the importance of their referral decisions and the choice architecture therein will continue to be unsustainable and cause unintended harm to patients and providers alike. At Monocle Insights, we aim to fix that.
If you enjoyed this blog, have questions/comments, or would like to learn more about Monocle Insights, please email info@monocleinsights.com or visit our contact page to schedule a demo!
