In-person and virtual care: improving connection in a fragmented world

Stephanie St. Thomas
October 30, 2020

When American consumers turned to virtual care during the pandemic, they found that they liked it.

Who hasn’t changed their whole day because of travel to a medical appointment? Or spent too much time in a waiting room?

Virtual care offers an answer to consumers’ long-held wish for simple-to-access, digital healthcare, combined with in-person care when needed. Some of these sentiments include:

  • 89% of consumers say COVID-19 made telehealth “an indispensable part of the healthcare system”
  • 65% plan to use telehealth more after the pandemic  
  • 78% say that the pandemic has shown that more digital health options are badly needed

Many companies are innovating in the virtual care space, delivering care that would have been difficult to imagine prior to the pandemic. While these services grow in scale and adoption, these companies are also the first to recognize that virtual care does not replace all in-person care needs.

With the right connection between virtual and in-person care, innovative organizations can overcome existing fractures in care delivery for more seamless and positive patient experiences.

A strong referral network makes virtual care even better

Many virtual care companies offer deep specialization, such as fertility, behavioral health, or cardiac monitoring. As patient participation grows, so grow complexity and need for referral, whether to primary or specialty care, diagnostic services, or other facilities.

Whether care is delivered through telehealth, remote monitoring, in-person or through other virtual means, clinicians and patients alike want the referral experience to be smooth, helpful, and complete for patients. Ideally, referrals to lead to the best primary care or specialty provider for the patient. This could mean the provider:

  • Has the appropriate clinical expertise in a condition or procedure
  • Belongs to the patient’s insurance network
  • Offers a convenient location for the patient
  • Speaks the patient’s language
  • Communicates and collaborates with the referring provider

Establishing this “best referral” hinges on the availability of the right information during the referral process.

When provider data derails referrals

Referrals have long been a source of frustration for patients, providers, and provider office teams because the data underlying referrals is fundamentally flawed. At a certain small scale, providers can make successful referrals for patients. But as soon as insurance and geographies expand, referrals involve contending with provider data.

This data is half-wrong at its original source, the National Provider Plan and Enumeration System, according to audits by the Department of Health and Human Services. The many underlying problems with provider data include lack of a clear owner and a healthcare industry that’s constantly in flux, resulting in ever-changing provider affiliations and network status.

How high-quality provider data makes a difference

Better provider data can make a significant difference for every single referral and particularly in three common situations:

Clinical challenges

When a patient is experiencing a health need outside of your organizations’ scope, there’s a crucial opportunity to guide them to a provider with the appropriate clinical expertise. Insightful, clear data helps the referring clinician find the right provider.

Insurance coverage

Network designs and plan benefit details are complex and dynamic, creating a difficult hurdle as organizations increase patient panels. Clear, accurate data helps referring providers guide patients to in-network care.

Geographic expansion of virtual care

As virtual care companies expand to new regions, it’s necessary to build a high-quality network for referrals. Virtual care companies are seeking perspective on the provider landscape in any new region they serve. Both actions depend on better data.

Learn more about how Ribbon seamlessly supports the connection between telehealth and in-person care.

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