In the changing healthcare landscape, now centered around accountable and value-based care, effective referrals have undoubtedly become more important. Patients with chronic illnesses, for instance, may have more than one physician caring for them, and most primary physicians coordinate with many other care providers.
Certainly, at the New York City-based Mount Sinai Health System—a system that includes approximately 6,600 primary and specialty care physicians, seven hospitals, 12 minority-owned free-standing ambulatory surgery centers, and more than 45 ambulatory practices throughout the five boroughs of New York City, Westchester, and Long Island, as well as 31 affiliated community health centers, and refers hundreds of thousands of patients each year—the need for an intelligent referral operating system was clear.
Referrals must happen quickly and based on the urgency of each patient’s need, with health history and insurance information arriving securely ahead of patient appointments as needed. As such, Mount Sinai has recently launched a platform from the Newton, Mass.-based startup par8o, technology that is built on algorithms that match a patient to the right resource at the right time, enabling follow up that is appropriate and fast, officials of Mount Sinai say. Beyond referrals, the effort is meant to help patients navigate the health system.
The first phase will deploy par8o’s platform in medical practices that are part of the Beth Israel Medical Group within the Mount Sinai Health System, including practices that both send and receive referrals. Nearly 2,500 care providers are expected to use the system to start, along with roughly the same number of scheduling and support staff. The platform will be integrated into practice workflows through a desktop application and a secure web platform (e.g. in the cloud) that helps systems talk to each other. The second phase of par8o’s deployment will expand to include all hospital-based, affiliated, network, ambulatory site and interested voluntary providers across the health system, officials say.
“Major healthcare systems must care for patients in referral networks that shift people smoothly back and forth between well and sick care, and that track their progress at all times,” said Jeremy Boal, M.D., chief medical officer, Mount Sinai Health System. “Effective referrals are a foundation of ensuring high quality care across patient populations, and this new operating system will confirm that every referred patient is seen, and seen quickly.”
A Need for Speed
In 2013, when Mount Sinai and the New York City-based Continuum Health Partners completed a merger, the two organizations had very disparate IT systems. As a result, according to Bruce Darrow, M.D., CMIO at Mount Sinai, the two health systems were in a position to harmonize their applications, but first they needed to able to manage their referrals both within the system and do some tracking for their partners, even if they happen to be outside the system. “Mount Sinai isn’t unique in terms of having complicated patients, but what may make us somewhat different is that a lot of the primary care might be provided through the former Continuum hospitals, while a lot of the specialty care might be provided by the former Mount Sinai Medical center hospitals and practices,” Darrow says. “From day one, there was a sense that different parts of the organization should be able to talk to each other as quickly as possible.”
Bruce Darrow, M.D.
Darrow says the platform should ideally be pushed into the practices where the referrals could be managed on the outbound side, but in a way where you can rapidly onboard all of the receiving practices as well. “So even if you haven’t implemented the platform into a part of your system, providers can already be receiving those referrals—that’s how it works for external providers,” he says. “We will never go into their offices and implement the software, but they will still get incoming referrals that way.” Before this platform, says Darrow, Mount Sinai was using a combination of “low-tech” systems such as fax machines, phones, secure email communications, and giving patients pieces of paper saying ‘here call this number and make an appointment.’
As such, Darrow says that the physicians really appreciate the efficiency the platform provides thus far. “There are two categories of physicians, those who are sending referrals out and those who are receiving it. With par8o, it reinforces [things],” Darrow says. “The physicians who are happy with the way it works in terms of tracking and managing their referrals will be using it more. They will send it to a larger number of providers who are good about getting in touch with patients, making appointments, and giving feedback to the those referral providers, and that will lead to more referrals,” he says. “On the other hand, those who are not part of it and are not giving positive feedback to their referring providers, are losing that opportunity.”
Darrow notes that the par8o platform is largely database-driven with an analytics engine in background. Primary care practitioners, for example, will be onboarded with either something that’s integrated into their electronic medical record (EMR), or if that’s not possible, as a web portal. “Then it references a database of providers, so if I say I want to have my patient go see a urologist and I want to specify one in a particular neighborhood or with a specific sub-specialty, then I can do so via the web portal,” Darrow explains.
The information is managed by a central team but there is also the ability for providers to update it—if they want to have those referrals coming with the accurate information, they have a motivation to keep that information up to date, Darrow says. On the analytics side, the system tracks how quickly the provider received that information, how quickly he or she contacted the patient, when the patient was offered the appointment, and whether or not the patient made the appointment and kept it. There is good data from par8o that says if a patient didn’t make an appointment in the first day-and-a-half, then the chances he or she actually will do so drop off significantly, Darrow says.
Darrow does admit that there is a challenge of is figuring out how to best integrate all of the moving parts into multiple EMRs at Mount Sinai. “For instance, if we have one primary EMR that our primary care doctor is using to send out referrals, how to do we integrate that referral process into the EMR? We have to do so in a way that meets meaningful use criteria for transitions of care, and that could be complicated,” he says. “And how do we handle incoming information? Do we have it as a web portal or can we put it into the EMR? We haven’t bitten off those challenges yet, but I think we will be able to do so,” he says. Nonetheless, Darrow attests that the driver for the par80 platform is not meaningful use. “We were already working to meet that goal, so you had to have those mechanisms in process. Par80 wasn’t brought in for that reason, but you have to be mindful of the regulations around the transitions of care requirements and certified technology,” he says.