There are two sides of managing patient referrals to handle – inbound and outbound. In light of the growing need to adopt a low-touch approach that taps into technology while also leveraging workforce skills, Altura Centers for Health sought to make the referral management process as self-sustaining and automated as possible. To better tackle their increasingly large volume of referrals, they’ve begun to implement a new referral system that manages most of the inputs, thereby freeing up more staff from the inbound referral processes. We hear from Arnie Reynoso, chief information officer at Altura Centers for Health, as he talks about their efforts to minimize the need for staff involvement in referral management, from referral to specialist review, scheduling, and ultimately, patient care.
🎧 Listen and subscribe to CCI’s Health Pilots podcast on Apple Podcasts, Spotify, and elsewhere. Below is a transcript of the episode, edited for readability.
🎙Podcast production services by Wayfare Recording Company.
Episode Teaser // Arnie Reynoso (guest):
The influx of inbound referrals has exponentially grown. So what we’re hoping is to free up those individuals that are handling inbound referrals because we do have another side of the coin where we have to refer out too, and that’s actually even larger. So we’re hoping to self-serve those that are referring to us to free up our staff to be able to handle the referrals that we’re actually pushing out.
Health Pilots podcast intro:
Welcome to the Health Pilots podcast presented by the Center for Care Innovations. This podcast is about strengthening the health and wellbeing of historically underinvested communities. Every episode offers new ideas and practical advice that you can apply today!
Jessica Ortiz, Center for Care Innovations (host):
Hi, I’m Jessica Ortiz with the Center for Care Innovations and today we’re talking about one of the exciting projects that Altura Centers for Health has been working on for the past seven months. Our hope is that by sharing the highs and lows of this digital health solution, safety net organizations can apply the lessons learned to their own challenges. I’m here with Arnie Reynoso, member of our Tech Hub Learning Network, which is comprised of 14 tech forward, California-based community health centers, clinic coalitions, and primary care departments in county health systems that are working to accelerate the adoption of innovative technologies. We partner with our Tech Hub members to vet, pilot, evaluate and spread innovative digital health solutions, serving Medicaid markets and historically underinvested communities. We are excited to bring you this story today. Arnie, can you start off by just introducing yourself? Share a little bit about you and your organization.
Arnie Reynoso, Altura Centers for Health:
Sure. Thank you, Jessica. My name’s Arnie Reynoso, I’m the chief information officer at Altura Centers for Health. Altura’s been providing medical and dental care to California Central Valley since 1995, primarily in the city of Tulare, California – though we do have a remote sort of rural clinic in Woodville, California. We are in FQHC. Altura provides services such as family medicine, pediatrics, obstetrics, dental, chiropractor, behavioral health. And we actually do have a litany of specialists that we have here onsite that provide other services as well.
Jessica Ortiz:
Great. Thanks for that background. We’re really happy to have you today, Arnie. So let’s just jump right in. Tell us more about your project. How did you get started?
Arnie Reynoso:
Well, the project kind of started a few years ago with us trying to figure or determine how to best handle our referral management. And so we did bring in a vendor called HealthViewX that brought us a solution to streamline that process. Primarily it was to handle most of our outbound referrals as our PCPs were referring out. But in the last couple of years, we’ve noticed an increase of us being referred into us with our specialists that we have here in-house. And so that created more of a opportunity for us to sort of revisit and what we could extend our current solution to be able to streamline that process.
Jessica Ortiz:
Great. And so what have you learned so far? What’s been the highlight of this project?
Arnie Reynoso:
Well, the highlight has been that we envision having less staff dedicated to this inbound referral processes by allowing our referral system to handle most of the inputs into the system and actually the creation of the charts and sort of the process in which the referral stages go through as it’s being referred into us.
Jessica Ortiz:
And can you just tell us a little bit more about the solution that you’re working with, HealthViewX?
Arnie Reynoso:
Yes. What we were wanting to do is streamline our inbound referral process by making it more web-based. Where previously it was very manual, it was fax and phone call where we would get the referrals into us. And so, this will actually allow the PCPs (primary care providers) when referring to us to actually go to our portal, enter the patient’s information, and thus feed it into our health referral system. That way we could streamline either by creating a patient’s chart in our EMR or actually merging that information if that patient does exist in our system already.
Jessica Ortiz:
And how many inbound referrals are you seeing per month?
Arnie Reynoso:
Well, we were initially only seen on an average about four to five a day, so about 90 a month. Now we’re looking at 250 to 350 a month, which significantly increased staff load, which is why we were trying to determine how to streamline this process.
Jessica Ortiz:
And what are the subspecialties that have the most volume?
Arnie Reynoso:
Right now, it’s mostly our cardiology department [that] has lots of inbound referrals. We’ve got podiatry as well that has it. Internal medicine as well. So those are sort of the primary ones that we handle right now.
Jessica Ortiz:
Great. What about new patients? If there are patients that are new to you, do you handle the registration? How do you handle the registration in creating a medical record for them?
Arnie Reynoso:
Yeah. So the registration’s quite simple. Once the information is entered into our web portal, it goes to our health management system. And then from there it’s sort of staged. And once it’s there, we have it mapped where we could, in a click of a button, actually create the health record in our system itself. And at that point, usually the way our process works is the referring provider will look at the data that was being sent to us and determine whether it’s something that is within their scope and they could handle. And at that point, it starts going into the scheduling process and then define that.
Jessica Ortiz:
And what was the training process like? How do you go about training the referring providers and what’s required to make a specific referral?
Arnie Reynoso:
So the referring process is quite simple. All they have to do is enter all the pertinent information that is required on our webpage and attach the pertinent documents for the referral to be looked at. And then once it’s vetted by our referral specialist, then we continue with the process of scheduling them and then ultimately bringing them in to be seen.
Jessica Ortiz:
I’m curious, this seems like a little bit complex, the sharing of information back and forth, and so I’m just wondering how does that work with this process that you’re talking about with HealthViewX? How do you get the reports back? How do you get the information sent from the referring providers? How does that really work?
Arnie Reynoso:
Well, the way it works is the referring provider is required to provide a main contact method, which we recommend or at least suggest it be via email. And so our system’s able to not only attach documents that are in our referral system and sent back to them through that system, but if we received documents also back into our system, they can easily attach additional documents into the system so they don’t actually have to email them. The email that goes out to them actually has a dedicated link that would allow them to attach whatever documents to that specific referral if we need any more documentation from them.
Jessica Ortiz:
Great. Arnie, can you just share, I know that you’re still in the stages of launching this and have done all the work in preparation. What’s the big picture? What are the key results you’re looking for from this work?
Arnie Reynoso:
The influx of inbound referrals has exponentially grown. So whereas before we would have maybe a half a day of a staff member handling this on a daily basis, it started becoming now one individual and then it led to two full-time staff handling all our inbound referrals. So what we’re hoping is to free up those individuals that are handling inbound referrals because we do have another side of the coin where we have to refer out too, and that’s actually even larger. So we’re hoping to self-serve those that are referring to us to free up our staff to be able to handle the referrals that we’re actually pushing out.
Jessica Ortiz:
Totally makes sense. I’m curious in, you’re nearing the implementation of this project, have there been any challenges leading up to planning for launching this 2.0 version?
Arnie Reynoso:
Well, the first challenge is actually getting the providers or PCPs that are referring to us to actually use the system, more because they’re accustomed to doing it a certain way. We do have, I guess, the upper hand, I guess in the sense, given that they’re referring to us. So it’s quite easy to push them in that direction, but there has been a lot of pushback to the point where we’ve basically given them a hard deadline that says, “After this point, we will no longer accept referrals except if it’s being used through our portal.” And so that’s easy to handle. Unfortunately, the other side of the coin is our referrals as we’re referring out, and this doesn’t necessarily touch on this aspect of the project, but it’s been a challenge getting those referrals or those specialists to actually adopt or at least use our system so we could easily transfer data between us and them. So that that’s a bigger challenge into itself, but we’re tackling at least one side of the coin right now.
And I would also add that as part of streamlining this, there are some manual processes that still take place. One of them being a specialist actually looking at the referral and ensuring that it is adequate for them to handle. And then our staff actually then scheduling that appointment in our system as far as that’s concerned. But apart from that, this whole effort has been to automate the remainder of that process from being inputted into our portal to eventually be seen by our provider.
Jessica Ortiz:
Yeah. One step at a time, it seems like that. And this one you have a little bit more leverage with, and the next one is going to be a bigger challenge, but I’m sure that you’ll get there and have those conversations. I’m curious if you have any advice as you’re going through this process, anything that folks should be considering if they’re thinking about implementing a similar approach to referral management?
Arnie Reynoso:
Well, definitely one thing that I would advise and which is why we ended up with the solution we have, is the willingness for the vendor to tightly integrate into the EMR. I mean, they’ve been very good at being able to tap into the necessary database fields to be able to import all this data kind of “automagically” in a sense. So that’s been great as far as that’s concerned. So we did have to work with them and try to determine where we wanted the data and how it wanted to be presented, but once we determined that their willingness to actually do the work on their end to be able to put the data where we needed it, was quite nice.
Jessica Ortiz:
And could you share a little bit more about that process? I’m assuming that there was a little bit of thinking that go went into that. What is the organizational fit and sustainability of working with this particular solution? Were you able to have conversations early on with them that led you to believe that they would make all of those changes? I’m just curious how that process went.
Arnie Reynoso:
So yes, we did have early conversations with them to be able to determine the feasibility of them not only replicating our database, but being able to tap into the necessary fields. Some of them being either read-only, some of them being read-write only, and things like that. So yes, their willingness to do it. Plus they had experience with the NextGen itself, which is our EMR. So that sort of made it an easier sort of cleaner fit for us in that aspect.
Jessica Ortiz:
And this is kind of a separate question, but have you thought about creating an e-consult type of interaction so that only the most appropriate and best prepared clients or patients arrive to see the specialists that you have?
Arnie Reynoso:
We have considered doing something like that, sort of onboarding them, having them access or at least have access to our same system with certain privileges to allow them to communicate with us and being able to exchange that information from us. So yes, it is a consideration and it’s something that I know we have discussed, but we’ve been trying to figure out how to best, I guess, accomplish that or at least streamline that type of process.
Jessica Ortiz:
Yeah. It sounds like we were saying earlier, there’s these kind of bigger problems, which you’re starting incrementally, making sure you’re streamlining those processes, make sure they work, and then building on those successes.
So my next question for you is about just the fact that you’re part of our peer learning network, the Tech Hub community, and here we’re big believers in collaboration and not reinventing the wheel. And I’m just curious if there have been any particular peers or resources that you’ve used just to help you think through this project and your work?
Arnie Reynoso:
Yeah, no, actually there have. I have been in contact with a couple of peers particularly that are on NextGen system, just like we are, to determine what they were doing in if they were handling something similar like this. I think all of us do have a different system that handles referral managements, so that’s something that I know that I want to follow up to see if there’s potentially something that they may have that we could learn off of or vice versa when it comes to that.
Jessica Ortiz:
So Arnie, I know you were talking about, it’s really helpful to be a part of a learning network that where you can bounce ideas, especially if someone else or another organization is using NextGen, for example, EHR, there’s like similar considerations. I’m curious if someone wants to learn from you, would you be willing to be that person to share how this is going in the future?
Arnie Reynoso:
Yeah, absolutely. I mean, anyone interested in looking for a referral management solution and what are the pros and cons to different approaches to it or looking at implementing something similar, absolutely.
Jessica Ortiz:
And you touched on this a little bit earlier when we were talking about the bigger problem of the outbound referrals. But I’m just curious, with this project, what’s next? What’s the step for you?
Arnie Reynoso:
Well, the next step is we haven’t necessarily launched because not only have we tightly integrated it with our EMR, but we’re actually hoping to integrate it with our two-way texting platform as well, so that patients get a status of where their referral is in the process automatically.
Jessica Ortiz:
That’s great. Just streamlining a lot of those things can often be really complicated.
Arnie Reynoso:
Yes. Yeah. And like I mentioned earlier that we’re sort of trying to make this as self-sustainable or as self automated as much as possible to involve as minimal staff time as possible through the entire process from being referred in to being reviewed by our specialist to being scheduled to then going through that litany until the patient actually gets seen by the specialist itself.
Jessica Ortiz:
Yeah, that’s great. A lot of the folks that I’ve been talking to lately in the projects that they’ve been working on are, how do we use the lowest touch approach when appropriate to get the work done? I mean, particularly with all the workforce challenges that everyone’s experiencing, it’s really important to see how we can leverage technology to still get the work done, quality care, and also utilizing the skills of the workforce where it’s most needed.
Arnie Reynoso:
That’s correct. Yeah.
Jessica Ortiz:
Yeah. Well, thank you, Arnie. It’s been great to chat with you. You are an incredibly valued member of our Tech Hub Learning Network and we appreciate you sharing your expertise and experience with us today.
Arnie Reynoso:
All right. Well, thank you for having me.
Health Pilots podcast outro:
Thanks for tuning into Health Pilots hosted by the Center for Care Innovations, with podcast production services by Wayfare Recording Company. If you like what you heard, please spread the word and be sure to subscribe where you listen to podcasts. For more information about the Center for Care Innovations or for upcoming programming, events, and funding opportunities, please visit our website – careinnovations.org – and connect with us on LinkedIn and Twitter. We’ll catch you here on the next episode of Health Pilots!
Find this useful or interesting? We’re constantly sharing stuff like this. Sign up to receive our newsletter to stay in the loop.