Keeping patients in a provider's network has become even more of a priority as health systems look to rebound from the COVID-19 pandemic, according to a new survey.
Almost all of the 138 health system and hospital executives surveyed in January and February said minimizing so-called "patient leakage" was a priority in 2020, which is when patients migrate to another health system or when they don't follow through on referrals. But many organizations are not prepared to combat that migration, as around 40% of executives were not confident they had the ability to track how patients flow in and out of their systems, according to a survey commissioned by Central Logic, which helps systems manage referral networks.
"Pre-pandemic this was a big issue—health systems were losing billions of dollars in lost revenue from patient leakage," Central Logic CEO Angie Franks said. "This will be key for value-based care. Add in the pandemic and it becomes even more imperative."
Health systems have continued to acquire physician groups, which adds layers to their already intricate referral network. If in-network provider lists aren't updated frequently or if IT infrastructure isn't optimal, health systems often lose track of patients and care can suffer.
As a result, most accountable care organizations, for instance, lose about $200 million to $500 million per year due to network leakage, one estimate shows.
COVID-19 has raised the level of urgency. Health systems and hospitals lost key revenue sources as non-urgent surgeries have been intermittently delayed while organizations braced for COVID-19. Emergency department volume has been the slowest to recover, which is a primary referral source.
Prior to the pandemic, three-quarters of executives surveyed said patient leakage was a significant obstacle to meeting financial goals.
"You can't cut your way out of this problem," Franks said. "You have to solve tougher problems and put in place a foundation of controls for referrals. The value of every patient is more critical than ever before."
The most common obstacle to retaining patients is competition, according to the survey. Patients will go to other providers that offer a more streamlined patient experience. The next most prevalent issues were service line gaps, slow acceptance and area physicians who are not aware of the available services.
A common solution has been to increase the number of access points by buying more physicians. But network configuration often lags, said Jimmy Burnett, a partner at consultancy Guidehouse.
"They buy up a bunch of practices and then find out that 60% of their specialty referrals are going to a competing hospital—then they are cooked," he previously told Modern Healthcare.
While nearly 80% of executives have been trying to improve patient retention for more than three years, only 55% had the tools to address the issue, Central Logic found. About 30% of C-suite leaders were not confident that their organization could track how many patients left their system.
Health systems should treat their organization like a business, and invest in the technology and support to boost their service-line operations, Franks said.
"Health systems have to lock up their primary-care base and referral network so they can operate as a system of care rather than a collection of individual fiefdoms of hospitals," she said.