How Kicksaw is Helping Providers Lead the Way with Next Gen Provider Referral Management (PRM)

Kicksaw’s expertise evolves with every client project — and our approach to provider referral management (PRM) is a perfect example of putting what we’ve learned into practice. 

We’ve worked with a lot of providers to improve their PRM solutions. It’s proven to be a keystone process, where a successful strategy has positive effects on other areas of their business. No matter the types of patients they serve, providers that succeed with PRM win by: 

• Developing world-class relationships across their provider networks that drive practice growth
• Elevating the patient experience, from the first touch point all the way through their care journey
• Delivering better outcomes with more time spent with patients and less time spent on operational processes 

While virtually every healthcare provider can benefit from a strong PRM solution that builds on what a platform solution offers to improve KPIs like cycle time, leakage rates, and volume processing, with speed, efficiency, and scalability — we’ve found certain types of providers face unique challenges when it comes to referral management in their respective markets.

Next Gen or Next Generation PRM is the result of lessons learned from clients that have these unique needs and require something more out of their PRM solutions, for example: 

• Competitive Referral Networks: Using Speed as an Advantage - for providers operating in environments where referrals processed quickly offers clear benefits
• Empowering Distributed Caregivers and Field-Based Care Resources - for providers with unique resource management requirements or those delivering services in new ways (e.g., home and ambulatory care through large networks of remote caregivers)
• Growing Provider Networks: Filling the Referral Funnel - for those growing or looking to grow at a hyperscale pace

In this blog we’ll help you understand the importance of Next Gen PRM solutions, which providers they’re most crucial for, learn more about the unique requirements mentioned above, give you Next Gen PRM solution examples, and provide KPI-focused questions to help measure your own PRM solution’s performance. 

Next Generation PRM Solutions

To get a better understanding of why a Next Gen approach to PRM is so important, it helps to take a closer look at PRM's role in the HLS marketplace: 

• The inbound referral management market was valued at USD 4.17 Billion in 2023 and is projected to reach USD 13.48 Billion by 2031, growing at a CAGR of 15.8% from 2024 to 2031

Why are provider organizations projected to spend this amount on PRM?

• It’s ability to help them take advantage of segments which can expect higher growth in profit pools, and for areas with slower growth, put them ahead of the competition

To maximize market share, provider organizations need PRM solutions and processes that are able to effectively capture volume and build sentiment from the top down, adding to the patient funnel alongside providing an excellent patient experience from the first point of contact and building world-class relationships with your provider network. 

Next Gen PRM solutions:

• Serve the needs of modern providers in dynamic marketplaces where speed, efficiency, and scalability serve as value drivers for a differentiated referral management strategy 

• Create value for all providers, but have proven to be critical for fast-growing sub-specialties like Home Health, Behavioral Health, and Radiology

Next Gen PRM Solutions: Requirements and Examples

Let's take a look at those unique characteristics or requirements for Next Gen PRM solutions mentioned in the beginning of this blog, and then link those goals to Kicksaw client and Next Gen PRM projects — with descriptions and solution examples — to better illustrate what a Next Gen PRM solution looks like in action.

Competitive Referral Networks: Using Speed as an Advantage

Digital transformation is still a work in progress for many providers, with accelerating legacy referral processes being a common goal to cope with the competitive nature of the marketplace.

Rather than simply putting automation in place, a Next Gen PRM solution is one that removes friction between IT infrastructure, making the most of multi-point, real-time integration to:

• Provide an advantage where providers are competing for the same referred patients
• Helps ensure compliance (for example, moving communication from email to secure integration)
• Improve the patient experience with faster and more streamlined access to care

Provider and solution examples:

Home Health Provider that needs automated distribution, acceptance, and/or rejection of referrals based on 48-hour time constraints.

• Solution - Salesforce Health Cloud's intelligent form reader and an eFax connector streamline lead creation by automating data extraction from emails and location-based therapist searches and time alerts using Slack

• Outcome - Faster time-to-referral, ability to process a greater volume of referrals, and better able to target post-appointment revenue opportunities

Radiology Provider rep teams work with providers to generate referrals, but lack of tracking functionality in CRM means duplicate data entry and an inability to understand how many patients are referred vs. scheduled vs. completed.

• Solution: Salesforce Health Cloud used to establish CRM and manage and track provider, referral, and patient information; Konica Minolta Exa (RIS/PACS) integration to create referrals in Health Cloud based on orders from referring physicians 

• Outcome: Tracking of referral and rep activity easy to manage; effectiveness of business development reps improved with better insights into the health of their provider network and clear visibility into referral progress, volume, and outcomes 

Empowering Distributed Caregivers & Field-Based Care Resources 

Home health care providers are the usual suspects for this requirement, but use cases within this requirement vary widely. 

It’s worthwhile to note that a large percentage of providers with distributed or field-based resources overlook the importance of integrating management and tools for those resources into their overall PRM solution — although it’s a unique strategic opportunity for them to help differentiate themselves in the market.

In this case, a Next Gen PRM solution would work within time and budget constraints to leverage improvements that can be shared amongst a larger group of users, offering value through:

• Tools for large, dynamic networks of care resources (with an emphasis on mobility)
• Efficient care resource matching, which is agile enough to meet evolving criteria
• Accurate and trackable distributed referral assignments 

Provider and solution examples:

Home Health Provider with hundreds of field-based PT/OT providers that offers location-based therapist matching, and handles referrals from physicians, hospitals, nursing homes.

• Additional requirements: referral coordinators need efficient location-based matching processes to recommend and assign referrals; flexibility for therapists needed to enter structured data in a collaborative workspace

• Solution: Centro used to enable Slack messages to be sent from Health Cloud, SFTP and Slack integration to enhance case management flexibility, Slack used for post-evaluation form submission

• Outcome: Easy data syncing and the ability to scale out the assignment and distribution of referrals across a large and growing network; establishment of a process for automated, efficient patient and caregiver matching; care coordinators can focus more on relationships and less on admin tasks, boosting therapist retention and care quality

Home Health Provider with a growing network of over 2,000 support professionals in the field matched with patients based on capacity, availability, and location; timekeeping, logging auditable shift notes, and EVV (electronic visit verification) are high-value problems, along with establishing and maintaining comprehensive provider profiles.

• Solution: Salesforce platform used to establish a CRM foundation, streamline communication, track activity, and with patient and resource matching; Nextiva used for telephony tracking and integration to support patient intake/matching

• Outcome: Time and money saved with efficient patient and resource matching processes; removal of communication barriers improves user-friendliness for resources, along with better patient outcomes and quality of care; integrated profile management and tracking decreases time-to-care/services for patients

Growing Provider Networks: Filling the Referral Funnel

Often the next steps after streamlining operational processes involve increasing referral volume and the size of the provider network, along with performance — which tie in directly to organizational growth.

Next Gen PRM solutions are about taking a great system and feeding it. They can be used to provide analytics and tracking to help measure PRM KPIs, and do so holistically, rather than keeping that information in a silo, to help inform decision making and improve a provider’s ability to:

• Measure referral network growth and direct business development efforts or activities, in order to make the most out of limited resources
• Drive awareness and provider recruitment through marketing and targeted outreach 
• Increase the size and quality of your provider network through inbound referrals

Provider and solution examples:

Behavioral Health Provider with reps that need the ability to accurately tie information back to providers, see the full impact of referrals, and understand where to focus efforts.

• Solution: PRM for Salesforce Health Cloud to track current, prospective, and old referral sources (clinicians and providers); EHR and IntakeQ integration to push patient data to Salesforce so it can be accurately tied to providers and update them about referral status; IntakeQ will also push financial data to Salesforce so it can be linked to referrals

• Outcome: Reps and management can see the revenue impact of referrals, conversion rates to help increase volume and growth, and data to generate future service revenue; referring providers can easily access information about the status of their patient referrals 

Radiology Provider with field reps who own territories across a large city and metropolitan area that visit referring providers in the field; need ability to analyze network performance and track correlation with marketing activities.

• Solution: Referrals stored as leads in Salesforce Health Cloud and referral activity can be managed via reports and dashboards; Salesforce Maps used for provider contact and territory management, as well as route optimization for reps; CRM Analytics added to maximize the use of their data

• Outcome: Referral pipeline easy to manage and track, on platform insight into expense and campaign cost management, data presented in a clear and precise for faster and improved decision making

Measuring Your PRM Solution’s Speed, Efficiency, and Scalability

If anything you’ve read in this blog resonates with your own organization’s requirements, goals, or strategy, taking a look at your current solution’s KPIs is a great way to start measuring your own PRM solution against what a Next Generation PRM solution can deliver.

• Referral volume is important regardless of your sub-specialty; taking a look at the total number of referrals received from other providers over a given period can indicate the effectiveness of referral relationships and marketing efforts

• Referral leakage rate measures the percentage of patients referred out to other providers, which can indicate areas where the organization may need to expand services or improve care coordination

• Referral cycle times measure the time it takes from receiving a referral to scheduling and completing the patient's first appointment can indicate efficiency and responsiveness in the referral process

The Kicksaw team is also happy to help with next steps or discuss your specific goals with PRM, please don’t hesitate to contact us for assistance with your own Next Generation PRM solution.