At-risk provider groups including accountable care organizations (ACOs) and clinically integrated networks (CINs) trust ReferWell with their most critical value-based care initiatives. ReferWell helps ACOs gain a clearer picture of their provider networks, regardless of the many EMRs physicians use, so they can direct care transitions to the highest quality, lowest cost providers. And, ACO leaders can feel confident that doctors are keeping their members in-network.
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.
“This is medicine the way it's supposed to work.”
– Medical Director, independent clinic network
Drive Patients to In-Network Providers
See how a major metropolitan hospital system used ReferWell to reduce leakage by 57% and increase revenue.
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Explore Solutions for ACOs
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.
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.