How YourCare Continuum Cuts Through the Maze of Lost Referrals with Gina Williams

Host: That's Gina Williams, product manager at MEDHOST. She's currently working on YourCare Continuum, an orders-integration and appointment-scheduling platform that makes it easier and more enjoyable for patients to get the help they need. She gives us an example by walking us through how a patient previously had to navigate a maze of manual referrals, admissions, and follow-ups for each provider they sought care from and how YourCare Continuum cuts down on the frustration that stops people from accessing critical services.

Gina: At the end of the day, these providers want their patients healthy. And they want to be able to take good care of their patient so that they can see new, healthy patients rather than continuing having to treat the same person for the same thing because they're not getting the other treatment that they need.

Host: This is Health IT on the Record, presented by MEDHOST, a show that dives into how health information technology innovations impact every aspect of a health system from multi-hospital networks down to individual patients. Alongside an enthusiastic beta partner, MEDHOST is working to cut down on the 54% of fax referrals and 50% of call referrals that fall through the cracks to create a better, more reliable experience for both patient and provider. Enjoy the conversation.

Gina: Hello. My name is Gina Williams, and I'm a product manager at MEDHOST. And my latest project has been to help identify problems, to help craft a solution, and to sort of shepherd a beta launch for our new YourCare Continuum product.

Host: Community Bridge. Walk me through just the context of all of this: why there's a pain, what you've been working on to take away that pain. And let's just start there.

Gina: Sure. So the problem that exists across the entire healthcare ecosystem is that patients and providers are largely disjointed. So as patients move through multiple providers of care including physician practices, acute care health setting, etc., the coordination and transition of that care is critical for ensuring the best patient outcome and ensuring a satisfied patient. I was going to say happy, but I think satisfied is probably the better way to say that.

Host: Right. So kind of if you were to make this an example, just like making up a name, could you walk me through this broken model?

Gina: Sure. So Clark –

Host: Yeah. Use me.

Gina: Yes. Clark shatters his leg skiing and is taken to the emergency department. Physician there patches up Clark's leg and says, "Okay. Now you have to go see specialist. You're going to have to go see an orthopedist. I'm pretty sure you're going to have to have surgery, but I want to refer you to an orthopedist to evaluate."

You go to the orthopedist, and the orthopedist says, "Yeah. This X-ray looks bad, but I really want you to have an ultrasound." So they refer you back to the hospital for an ultrasound. They get those results back and say, "Yep. You're going to need surgery, and you're going to have to spend the night. So I'm going to go ahead and put in all of my admission orders and everything in at the hospital for your stay."

Then you have surgery. Well, then you need to follow up with the orthopedist, and they also want you to follow up with your primary care physician so that he can be fully aware of everything that you've been going through. This is a lot of transitioning of care across multiple providers for Clark. And with no electronic coordination, all of that is manual. So all of those orders, maybe the MRI or the ultrasound that they want Clark to have, they print out a piece of paper and hand it to Clark. And then Clark leaves it in the car when he goes.

Host: Right. I do that.

Gina: And they won't let you have the test. So Clark, who already is in pain because he's got a broken leg, has to go back to the car to get the order before he can come back and have the test done. So it's really inconvenient. And you're asking people who are already not well, typically, if they're moving across providers like that – so we were trying to look at some way that we could tackle that one bite at a time. It's a huge problem.

One of the things that MEDHOST already had was electronic orders. So we have the orders back and forth electronically, but there's no workflow around those orders. So there's still a lot of things that have to happen to that order in order for it to be closed to say, "So all pre-registration activities have to happen. You have to make sure that it's medically necessary. That if a pre-authorization is needed from insurance, that that's obtained. That the preregistration activities in the hospital are all done before Clark gets there for his test."

And so for the appointments, again, a disconnect because if Clark is leaving the physician's office, and they can't get you an appointment on the phone, they're going to let you leave, and they're going to say, "Okay. Clark, make this appointment." And then it's up to Clark to call the hospital and battle with call volumes to try to get that appointment scheduled. So it's just very fragmented, and it's not an enjoyable experience for the patients.

Host: Wow. Yeah. And when we're thinking about more of these pains, more of these problem points, to kind of just paint a larger picture of not – I love zooming in on one example and using me as a cool way to help make it feel even more real to me. But now, to zoom it out – so stats. Walk me through some of the big stats that have been on your mind just to really illustrate why this is such a problem with the workflow around the communication and the scheduling. And then let's, after that, we'll kind of move along to some of the challenges those create.

Gina: Sure. So faxed referrals, 54% fall through the cracks never resulting in a patient getting a test needed or seeing a specialist if that's needed. Call volume, I would say, 50% of calls never result in an encounter or an appointment either.

Host: That's just people calling in.

Gina: That's just people calling in trying to get an appointment. And so they end up frustrated and just never get the appointment made. So they never get the test that they need done or see the specialist that they've been referred to see. So a lot of these patients just fall through the cracks.

Host: And when that happens, what next?

Gina: Then it's the next time whatever incident that got them there in the first place flares back up, and they end up back in the emergency room or back in their primary care physician's office sick again.

Host: So from the patient experience side, that's, of course, terrible. But what about on the provider side? What kind of pain point does that create?

Gina: At the end of the day, these providers want their patients healthy. And so what that means is their patients are coming back in unhealthy repeatedly, right? And they want to be able to take good care of their patients, have their patients not coming back to them if possible so that they can see new, healthy patients rather than continuing having to treat the same person for the same thing because they're not getting the other treatment that they need outside of their office.

And a primary care physician can only do so much, right, in terms of caring for you. At the end of the day, a specialist - an orthopedist - has to actually replace your hip. Primary care physicians can't do that.

Host: That all makes sense. Any other stats come to mind as we kind of move along here?

Gina: On that, to me, is very compelling which is 3 out of 10 tests have to be reordered because the results can't be found. So it's kind of the opposite problem in that the patient actually did make the appointment, they had the test done, but they have to go have it repeated because nobody can find the results of the test. So imagine how angry a patient would be and how frustrated they would be with the healthcare system to have to go have an MRI repeated just because somebody can't find the results.

Host: That is unbelievable. And of course, that's just more costs on the provider's side.

Gina: Oh yeah, because they can't bill insurance twice for the same procedure just because they lost the test results.

Host: Right. That's definitely a bad experience on the patient side. So one of the reports that I've been looking through from the MEDHOST side – there's a theme on consumerism, of course, right – consumerism and how self-scheduling is something we all know is important. But how much does that matter from both sides here?

Gina: For the physician's office, it's extremely important. I mean, that streamlines that for the patient incredibly when sending them to the hospital for these tests because if they can go ahead, have that appointment scheduled, have that patient make that commitment that they're going to actually go and have the test made, they've done that with you, the patients are just a lot more likely to show up for the appointments and get the test done.

And it's just a better experience for the patient because you don't have this back and forth over, "Are you available at 3?" "No. I'm not. I'm not available on Tuesdays." And you have to do this whole back and forth. When the person checking you out at the clinic just pulls up a calendar and says, "Hey, what works?" and you look and see what's available, and everybody seems more satisfied in that scenario.

Host: Health IT on the Record is brought to you by MEDHOST. With over 30 years of experience partnering with providers nationwide, MEDHOST is helping evolve better solutions for healthcare management through innovative workflows and technologies. For more information, visit www.medhost.com. Let's jump back in.

Host: So you've done a really wonderful job outlining the trends, the insights that you've been able to see up close and personal, the pain points that have led you to this point to build something to solve a real pain in the marketplace. But let's look through, now, the solution, this beta that we've been talking about, Community Bridge. What are some examples you want to look at of what it looks like when it's rolled out, how it helps both sides, all of the above? Can you walk me through that?

Gina: Sure. So one of the things with Grant Memorial is they had five clinics that refer into the hospital – five that are owned by Grant Memorial that refer into the hospital. They have about six others in their community. And the challenge was they have two people who received all the phone calls for all of the scheduling and were responsible for all of the preregistration activities that have to happen before a patient comes in. So they are not only inbound calls, but they're calling patients all the time verifying information.

So the call volume was just a real problem. A lot of times, patients had to leave their clinics without a scheduled appointment. And then it was up to the patient to have to schedule that appointment. And then many times, the patients were given a printed order. And then the patient forgets the order. So then when they show up to be checked in for their appointment, they're then back on the phone with the clinic to get another copy of the order faxed over because the patient can't find the order.

Host: And that's the case everywhere. It's not just Grant Memorial. It's just a pain point of when you have so many variable touch points, that's going to happen.

Gina: Absolutely. It happens. And so it was really great that they agreed. And they were so cooperative. It was amazing. Their physician, even when we were doing the beta, he would bring a patient down, and he would be like, "I have another one for you guys to schedule." He was really excited about it which was awesome, right?

Host: That's great.

Gina: I mean, having the physician buy-in on it – and I'm pretty sure that's why they chose that orthopedist to go first in the beta process. But it was awesome. And so it has really helped. I mean, their call volumes have decreased. Patients are more satisfied. They're leaving with appointments in hand. Any special instructions that need to be given to the patient are given at that time like, "You don't need to wear your jewelry when you come in for your MRI, etc." So that the business office folks aren't having to call out to patients and go through those instructions.

They're getting better information because the clinics typically have the most updated information on a patient. That's who they see often, right? And so they're getting more reliable demographic information with these pre-registrations. So that's helping streamline all of that.

And it has helped us craft our roadmap. So I'm able to now know that next in queue needs to be document upload for these appointment requests. We need them to be able to put in manual orders for things that aren't really candidates for electronic orders. We need to provide workflow for these orders so that all the preregistration activities can happen up front with workflow around it, so that it's far less of a manual process, so that the business office folks aren't having to go down a list of a calendar to see who have I checked medical necessity for, who has a pre-auth that needs one, etc.

That would all land on a work list and be streamlined for those folks in there to actually get everything done and prevent patients showing up with a test that's not medically necessary because the wrong test was ordered, etc. So I mean, it's been a huge benefit.

Host: This has all been wonderful. One of the final questions I would like to ask you about is just the whole implementation process. I know you've talked a little bit about that already. I like the example you used – bringing in the physician. But anything else you want to add of just being a partner and making something like this go live, making it work smoothly from the MEDHOST perspective?

Gina: From the MEDHOST perspective. So Grant was awesome to work with. They were enthusiastic. And one of the things that we loved about that was we were in the process of looking for betas when one of the account managers called me last winter and said, "Hey, I don't know if this plays into what your working on or not, but Grant is really looking at orders integration and appointments." And I was like, "Well, not only is that kind of what I'm doing, that's exactly what I'm doing."

So it was great that they reached out to us organically that way. And we formed the relationship that way as problem solvers rather than me reaching out to people and saying, "Hey, will you beta my product?" So number one, it started off strong that way.

And then Anna and I immediately clicked right away. We knew what problems we wanted to solve and what we were going in there to do. The clinic staff was amazing to work with. And we strategically crafted the solution to be as easy as possible for these hospitals to roll out because we're typically going to be there for one clinic to be implemented. Let them prove the value, and then they have to roll it out themselves beyond that. And so we had to make it super easy.

And I would say I spent four hours in the orthopedic office. And those ladies were on their own in about an hour. They didn't need me anymore. I was back in the break room and said, "Just call me if you need me."

Host: Just you're there in case – but yeah. Smooth, easy to understand.

Gina: We developed a 15-minute – like an LMS learning system that they can use to deploy. And that's what the others are doing. They're just watching the video, and that's all you have to do to use it. It's intuitive. It's easy. It makes sense. And we did that by collaborating early. So we actually created working prototypes, and put that in front of an advisory group, and incorporated that feedback before we ever built anything.

And then once we started developing it, we iterated on that feedback again. And we've incorporated that into releases. And I would say just as a beta partner, Grant has been awesome. They've given us good feedback. And we have actually already released a couple of things they asked us to add and have just really helped me get good product backlog for the next few releases.

Host: Well, I am so happy we got some time together to go over this. I always love to hear what you're working on now that we've had the chance to do some other projects, some other podcasts around some of the products that are coming out. But thanks so much. Gina, I really appreciate it, and I can't wait to reconnect soon in the future.

Gina: All right. Thank you very much.

Host: Thanks for listening to Health IT on the Record, presented by MEDHOST. For more stories and content like this, be sure to visit medhost.com/resources. Thanks.