Referrals and Care Coordination with Virtual Primary Care

According to a Commonwealth Fund report, just 50% of American PCPs (primary care physicians) said there is sufficient coordination with specialists and hospitals for patient care plans.¹ Compared to other high-income countries, the U.S. falls far behind in care coordination. In many instances, there is little-to-no follow-up to encourage a patient to schedule an appointment when referred to a specialist. 

Thoughtful referrals are also lacking. Most doctors find it too challenging to figure out whether a specialty doctor is in-network for a given patient. In fact, 79% of doctors end up referring patients to out-of-network doctors, which causes patients to spend more on healthcare costs.² An analysis found that patients who use care outside of their insurance plan pay from 118% to 1,382% more than in-network care.³ 

Seeing in-person specialists might be crucial for a person’s health. However, according to an analysis of EMR (electronic medical record) data of referrals from a large primary care network, “just under 35% of appointments have a documented completed specialty appointment.”⁴ Patients are receiving referrals to improve their health, yet they are not following through. Reasons for this include long wait times to see a doctor, geographic limitations or specialists being out-of-network. 

Here are some ways virtual primary care improves referrals and care coordination:   

• Virtual primary care supports the management of chronic diseases as people are more inclined to seek care due to its convenience: Patients can talk to a doctor via app, website or with a phone call. A better managed and treated chronic condition makes for more healthcare cost savings.   
• Whether a person has a chronic condition or is searching for a hands-on healthcare experience, virtual primary care can coach and guide patients on lifestyle modifications. Routine lab and screenings are ordered by virtual primary care doctors regularly (when appropriate) and virtual settings allow more time to review results.  
• In a virtual environment, doctors can spend more time with the patient and find the right specialist for them. With the support of virtual care teams, patients receive specialist referrals based on their preferences, geographic location, soonest availability and in-network status.  
• Hands-on virtual care teams send reminders for appointment scheduling to ensure patients complete their appointments and are adhering to treatments or plans discussed with their virtual primary care doctors. Collection of patient information is crucial in this process to secure medical history in one place for more convenient, medically accurate appointments in the future.  
• By managing referred in-person care, virtual primary care tracks and optimizes the many touchpoints of a patient’s healthcare journey and enhances the care coordination process.  

First Stop Health Virtual Primary Care  

First Stop Health Primary Care delivers patient-first care to coordinate and manage the many touchpoints of members’ healthcare journeys. Virtual doctors at First Stop Health focus on whole-person well-being care for members and keep the referral process managed to bridge together treatment plans, ensure medication adherence, and assist members when and where they need it. Plus, our Care Team ensures that referred specialists are in-network, in a convenient location and are taking patients in a reasonable timeframe. 

1. https://www.commonwealthfund.org/publications/issue-briefs/2022/mar/primary-care-high-income-countries-how-united-states-compares 
2. https://www.healthcaredive.com/news/physician-referral-issues-causing-more-out-of-network-care/530726/ 
3. https://www.cnbc.com/2015/09/30/the-much-higher-costs-of-out-of-network-health-care.html 
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5910374/