Keys to Keeping Care Within the Network

For a provider network to be successful in value-based medicine, he or she must coordinate patient care across the entire continuum of care. This is a complex effort, requiring collaboration among facilities, providers and services — using technology, data and analytics, all to achieve our goal of improved health outcomes at a lower total cost of care.

In addition, CMS, through its implementation of MACRA, has placed a strong emphasis on coordinating services within an ACO. The use of par8o can help ACN providers meet these expectations.

Part of ACN’s strategy to achieve our goals for a comprehensive active referral management program.

The technology that drives ACN’s active referral management program is par8o. Primary care providers use the cloud-based software platform to refer patients to ACN specialists who share their commitment to improving care, communication, coordination and outcomes.

In 2018, ACN updated its provider participation agreement to require that practices be enrolled to send and receive referrals through the online tool (as opposed to fax-based participation, where specialists can receive referrals to their fax, but the referral information is not updated in the par8o system). ACN further emphasizes in-network utilization (as measured by par8o data) in the Provider Rewards Program, with 60 percent of the incentive based on this metric. This aligns focus on and incentivizes behavior that supports better outcomes at a lower total cost of care. Performance data is available 24/7 on the provider secure portal or in the ACN Care Wallet.

Based on provider feedback, ACN and par8o continue to refine the tool. The most recent update to the referral search algorithm award greater weight and ranking to providers who respond quickly to the referral request and schedule the referral appointment within the recommended time frame. This aligns the priorities of the primary care provider, improves access to care and drives patient satisfaction. This improved both metrics: Time to First Action improved from 58 business hours to less than 24 business hours. And Time to Appointment improved from 16.5 to 11.4 business days.

This responsiveness encourages coordination of care and improved patient satisfaction.

If you want to learn more about how par8o can help you manage care within the network, ACN’s Provider Network Consultants (PNCs) are available to help you install the software, train practice staff and served as a network “Help Desk” to trouble-shoot any issues. Reach them at provider@azcarenetwork.org.

Can you explain how the ACN referral directory works? How was the system created? Is it similar to a find-a-doctor physician profile system?

• ACN does have a “find a doctor” tool on our website as well as an app, My AZ Doc. These are primarily for consumer use. par8o is a much more robust technology that:
• Matches the patient with in-network providers (for improved coordination of services within the network)
• Determines whether individual providers accept the patient’s insurance plan (for patient cost savings)
• Reports the distance of the specialist’s office from the patient’s home address or PCP’s office (for patient’s geographic convenience)
• Documents care notes from both PCP and specialist (for improved care across the continuum). The specialists’ offices receive the referral and log their actions; this allows the referring PCP to know whether the patient has followed through on the recommended care plan, thus improving outcomes. Following the appointment, the specialist can post his or her notes, diagnosis, and care plan, which improves communication among each patient’s care team.
• Par8o can be used by the practice for any patient, not just ACN patients, giving the practice one powerful tool for referral management (to improve practice adoption and provider satisfaction)
• ACN enjoys a collaborative vendor relationship with par8o. The metrics that drive the referral search returns are custom-designed for ACN based on the behaviors and outcomes that drive our goals. We have worked together to create, test, deploy, and support the program.

What were the goals of the physician marketing campaign for the directory?

• Our primary communication goal was to achieve 90% practice adoption of the par8o platform, leading to an increase in in-network utilization for ACN patients.

What formats and message delivery methods did you use for the marketing of the referral system?

• Most important was the support of physician leadership, including administrative physician leaders of our employed groups, physician board members and our own CMO.
• We used a variety of provider communication tools to educate, launch, train, and reinforce use of the software by all relevant members of the practice. This included email newsletters and bulletins, webinars, testimonials, quarterly Pod Meetings, messages on our secure portal, practice manager forums, and practice visits.

What role did print materials play in the campaign?

• Print was not the right tool for this rollout.

Was the campaign directed only to primary care physicians? Was practice staff also audience considered in your communications?

• Our primary target was ACN primary care providers as the initiators of most referrals and our initial focus was to roll it out to PCPs who see patients under our Medicare ACO contracts.
• Next, we targeted specialists as “receivers” of the referral – this messaging focused on the high value to specialists who want to grow their practice via network referrals.
• In both cases, practice staff are a key audience for this campaign – we trained practice managers and referral coordinators, highlight super users and solicited testimonials.

Do you have samples of marketing materials used to communicate with the employed physicians?

• Once you have reviewed this, let me know if there are specific examples of communication materials you would like to see. Much of our communication was PowerPoint presentations and simply talking them through the process.

At the outset of the campaign, what did your team define as “success”?

• Adoption: Our lofty goal was 100% enrollment of fully online users
• In Network referral rate and monthly referrals: Number of referrals successfully sent/received
• Improvement on key metrics:
• Time to first action,
• Scheduled within urgency
• Care Coordination performance

How did marketing to employed physicians differ from traditional physician marketing to an external audience?

• Our network is composed of providers employed by our owner health systems as well as independent practices
• In systems like Dignity Health and Abrazo, physician leadership drives behavior change – we have those leaders on our board of managers. They had insight from the very beginning into the value of our Active Referral Management and approved the entire plan.
• For independent providers who participate with ACN voluntarily, we must communicate the value proposition, provide data, train their staff and provide the post-launch support they need.

What were some key takeaways from this campaign? Where clinicians initially receptive/responsive?

• Core clinically integrated PCPs saw the value immediately –
  • It would be much easier to identify ACN patients,
  • A high satisfier for patients to have confidence that the referrals they receive are for in-network specialists who conduct their procedures at in-network facilities – this reduces hidden/surprise costs
• Aligned incentives are key to our network’s success – by incorporating on-line par8o registration in ACN’s updated participation agreement, and financially incentivizing in-network utilization and weighting referral recommendations, we pointed all parties in the same direction and working toward the same goals.

Some doctors like to refer patients to physicians they have a relationship with or a knowledge of their expertise. How does this system work for physicians who are uncomfortable referring their patients to specialists they aren’t familiar with?

• ACN Pod meetings are specifically designed to allow PCPs and specialists to meet so we have removed the barrier by helping develop relationships among PCPs and specialists.
• The search result weighting gives higher return results to specialists who will provide a better experience for both the referring PCP and the provider. Everyone wins in this collaborative relationship.
• For specialties they do not refer to frequently, par8o is a valuable resource that allows PCPs to refer with confidence.
• The size of our network offers broad choice in most specialties.

Arizona Care network has more than 5,500 affiliated physicians across multiple health systems plus hundreds of independent providers, so how did your organization work with the communication teams at the various institutions to have a unified communication strategy?

• The majority of ACN providers are independent, so our communication rollout was a multi-pronged approach directly to the practice (TIN) owner and their practice managers and referral coordinators. The only way to do it right it to visit them, offer a demonstration, answer their questions and provide support. This is a very “hands-on” process.
• The physician leadership of Dignity Health and Abrazo were very helpful in the rollout to their employed physicians. We provided information and they deployed their own internal systems to educate their teams.

Since ACN is comprised of three health systems, which can be seen as competitors to each other, how did you address concerns of losing patients to competitors within the ACO?

• The systems themselves created and support ACN, so they have already made the decision at the highest levels of the organization to partner together to provide excellent, coordinated care to our community. In fact, ACN is the only ACO in the country co-owned by two competing health systems in the same market.
• We have worked hard to communicate the importance and value of coordinating patient care within the network and our providers support that.
• Our health systems have good geographic distribution so in most areas, the medical groups are not direct competitors.

According to Athena Insights, ACN retained 89 percent of referrals in-network. Have you maintained that level of referrals? Is there an ongoing communication strategy to ensure those numbers don’t drop?

• One year post-deployment:
• 78% of all referrals (whether ACN members or not) within the tool are made to ACN providers; this increases to 86% for ACN members.
• 90% of ACN’s 1,400 office locations are “online”
• Average time to first action (the average time in business hours for a receiving practice to take action on a referral) has dropped from 51.21 hours to 15.37 hours
• Scheduled within Urgency (the rate at which a patient is scheduled within the timeframe requested by the sending practice) has improved from 67% to 77%
• At launch (02/17), monthly referrals were 1,200; by end of year, monthly referrals had reached 5,400
• Driving enrollment starts with the participation agreement. We reinforce usage with the Provider Rewards Program.
• We track usage data and our Provider Network Consultants round on practices to ensure they have a positive experience and/or remind them of the benefits of in-network referrals.
• We receive feedback from providers and incorporate that in continuous improvements to the tool.
• Ultimately, this multi-pronged approach has contributed to our goals of improving care, reducing total cost of care, improving provider satisfaction and driving a positive patient experience.