Get clear on network adequacy. End costly transitions and referral leakage.

Challenges Solved for ACOs

Understand Your Network Adequacy & Prevent Leakage

ACOs are asking ReferWell to create Virtually Integrated Networks so they can visualize their full provider networks in a way EMRs don't offer. By helping providers direct care transitions to in-network doctors and facilities, ACOs virtually eliminate patient leakage and the corresponding profitability hit.

Drive Care Transitions to the Optimal Providers in the ACO

We curate a complete list of in-network specialists so physicians can direct care transitions to the appropriate option, personalized to each patient's needs and your organization's value-based goals. Filter referral providers by insurance accepted, subspecialty, response time, location and language.

Coordinate Care With Specialists in the ACO

Regardless of what EMR(s) they use, we help ACOs share data between providers and specialists in their network. Send clinical data to specialists, track that patients completed their scheduled referral appointments, and then receive consult notes back at double the national average. 

Get Patients to Referral Appointments More Often

With ReferWell, PCPs schedule referral appointments at the point-of-care and the system handles all automated reminders. We're helping ACOs increase patient follow-through with recommended care by 60–110% across all beneficiaries.

Explore Solutions for ACOs

Referral Management

Guide in-network transitions across multiple EMRs, control leakage and understand network adequacy.

Care Gap Closure

Improve Star ratings, CAHPS scores and HEDIS measures. Close care gaps and boost satisfaction and outcomes.

Teletherapy

Increase access to behavioral health specialists and avoid costly complications and admissions.

About Accountable Care Organizations

Accountable Care Organizations (ACOs) are networks of doctors and hospitals who agree to work together towards providing quality, coordinated care leading to better patient outcomes at lower care costs

ACOs negotiate per member/per month reimbursements with CMS and take on financial risk for the care they provide. Based on meeting quality metrics, ACOs may either share in the savings with CMS or owe a portion of income received based on the network’s performance. As such, ACOs prioritize care efficiency and avoidance of duplicative care and unnecessary ED usage and hospitalizations.

Challenges Faced by ACOs

While ACOs are charged with providing coordinated care, the proliferation of disparate Electronic Medical Records (EMRs) within these networks often hinders care coordination. EMRs generally fail to provide sufficient referral decision support and make it difficult for providers to identify high-quality, in-network specialists.

When providers can't efficiently transition care within their network, the ACO suffers from poor network utilization or patient leakage and higher cost of care. In fact, it's common that ACO executives cannot accurately identify their network utilization or the steps they're taking to improve it.

Further, ACO executives often lack visibility into network adequacy, or which types of doctors and specialists are part of their network and whether they are following ACO protocols for providing care. Too often, the burden of finding care falls to patients, which leads to dissatisfaction and duplicative care, and specialists fail to close the loop, so referring providers are unaware if an appointment happened or a care gap was closed. These failures in access to care, member satisfaction and care coordination all have a negative impact on the ACOs quality metrics and therefore shared savings.