The US healthcare market is under increasing pressure to reduce costs, while improving healthcare. With healthcare costs exceeding 18% of the US GDP, and growing at a steady pace, it’s clear that healthcare systems and providers need to find better way to deliver higher quality patient outcomes, while reducing costs. Government regulation, such as the Hospital Value-Based Purchasing Program established by Affordable Care Act, is also putting pressure on organizations to move to value-based care and away from the transaction fee-for-service models. With these outcomes and cost-containment undercurrents in the healthcare industry, healthcare systems are scrambling for ways to increase efficiency and improve revenue streams.
Thankfully referralMD is uniquely positioned to help address some of these needs.
Platform Overview: referralMD is a San Francisco based health-tech startup with a mission of optimizing and solving the $150B referral leakage problem. We are a HIPAA-compliant, cloud-based technology-enabled service company focused on improving referral decisions and care planning of healthcare organizations by providing communication tools and clinical guidelines for expedited physician-to-physician (P2P) referrals and e-consults. We passionately believe in improving healthcare by embracing technology to empower physicians to deliver optimal care.
Target Market: The platform is offered to all organizations, (Providers, Hospitals, ACOs, IDNs, IPAs, PCHM, Payers) regardless of size or specialty allowing them to network with each other more efficiently.
A number of studies have shown that network patient leakage is a reality for the majority of healthcare systems, including ACOs. One study, by the Massachusetts Attorney General, found that with two different physician-hospital provider systems less than 50% of referral revenue actually was staying within the network. From the study:
Particularly for provider systems where hospitals and physicians are jointly at risk for the quality and cost of patients’ care, and have worked together to coordinate and improve care, we would expect to see physicians referring to their partner hospital more often. However, for the two physician-hospital provider systems in Massachusetts with the most years of experience managing referrals for HMO/POS patients under a global payment, one health insurer’s 2009 referral data shows that only 35-45% of adult inpatient care, as measured by revenue, goes to the partner hospital. That percentage can be even lower for providers with little to no experience managing where their patients receive specialist/hospital care, or under plan designs that do not require referrals.
referralMD is a change-agent for healthcare’s antiquated communication system, our software helps ACOs, IPAs, and hospitals manage their most valuable asset, their referral network.
The digital health market is growing at a tremendous rate with investments in 2014 over $4B, a 125% increase from 2013. referralMD has a unique advantage of having both a strong product built with the latest responsive web technologies and one of the most robust organic marketing distribution channels in the world.