Connecting Valuable ED Discharges with In-Network Specialist Care
Implementing an ED Follow-Up Navigation Program:
Care Continuity partnered with a large multi-state health system with 15+ emergency departments and aligned medical groups across 5+ Markets. The leadership team was focused on margin growth in several key service lines and identified the ED as an important source of specialist referrals. The health system had spent the last decade building a robust medical group of Tier 1 (owned) and Tier 2 (affiliated) specialist practices.
Identifying and Prioritizing Overlooked Referral Opportunities:
The organization found that more than 20% of ED patients were being discharged with specialist follow-up recommendations. However, these clinical recommendations were buried in discharge instructions, with no specialist referral order created and no centralized scheduling team assigned to help these unique ED patients. The health system needed a way to first identify these valuable referral opportunities in the ED, and then prioritize them for navigation services to ensure that high risk and high value ED patients were matched with limited specialist appointment capacity.
Optimizing for Service Line Growth and Network Integrity:
The organization decided to focus on competitive markets where network leakage from the ED was a particular concern. They targeted key service lines (e.g. cardiovascular) as part of a new program to identify high-value referrals from the ED and better navigate them to in-network specialist care. Working with Care Continuity, they rolled out a dedicated ED Navigation team to engage patients on follow-up care coordination and scheduling logistics. The program also included granular analytics to track the impact on downstream utilization and margin growth.
Impacting The Bottom Line
The health system monitored granular data for each service line, measuring the in-network completion rate for high-priority patient referrals. Baseline data was created for downstream utilization of Outpatient, Inpatient and Surgical services within 120 days from ED discharge. The health system saw meaningful growth in utilization rates and margin for high-priority referrals that received targeted navigation outreach.
- 15,000 ED discharges every month
- 23% have specialist recommendations (but no referral order)
- ED patients yield 2X average downstream revenue
- In-Network Referral Completion increased to 88%
- ED Return Rate decreased by 30% for high-risk ED discharges
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