Written by: Center for Care Innovations

Petaluma Health Center is a bustling clinic. It serves 34,000 patients who live in Sonoma County’s riverside city of Petaluma, formerly known as the “egg basket of the world,” as well as people who work in nearby farms, vineyards, cattle ranches, and coastal hamlets in the southern part of the county. In the last year the staff made more than 2,000 referrals to specialty medicine offices a month, but by their own count, only 50 percent of those referrals resulted in an examination.

Why were half the referrals dropping off the radar? Some referrals require approval from the specialist and insurance authorization, which greatly slows down the process. For patients, it is hard to figure out the status of their referral and whether it will be covered by insurance — a process they’ve found frustrating and difficult to manage, especially if they have multiple referrals.

The staff found the process equally frustrating and stressful. Patient would often call when administrators were in the process of getting an approval for someone else, causing tension and pulling them away from their job of coordinating referrals. Even checking on patients to see if they had seen a specialist took up an inordinate amount of time. But worse than the loss of time was the worry: A referral that went nowhere could put patients with chronic or life-threatening diseases at serious risk. How could they improve the process?