Leakage. It’s our problem.
Whether you call it leakage or keepage or network integrity or referral management or care coordination rate, the concept is the same. It’s vital to our network’s goals to provide the right care to our patients within our network.
It’s better for our patients clinically. When we refer patients within our network, we’re better able to coordinate and manage their care than when they access care at another network. Coordinated care leads to better quality and better outcomes.
In addition to being better for our patients, care that’s delivered outside our network is more expensive and negatively impacts our financial performance.
New reports coming from SOHO HEALTH: Care Coordination Rate
This summer, the team at SOHO HEALTH will be debuting some new reporting to look at our care coordination rate by practice and by provider. We’ll be starting by looking at inpatient costs as a measure of the care coordination rate because we know that inpatient costs account for approximately 53% of all of the medical costs in our network.
Care coordination rate is defined as the rate of care patients receive in our network as a percent of the total care received. For SOHO HEALTH, our network encompasses the hospitals of Saint Francis Hospital & Medical Center, Johnson Memorial Hospital, and Mt. Sinai Rehabilitation Hospital.
In 2017, based on the claims data we have, we found that of the more than $171M in inpatient medical costs our patients incurred, almost $70M of cost was incurred at a facility outside of our network; a care coordination rate of 60%. So far, in just the first quarter of 2018, we’ve seen the care coordination rate fall to 57%.
We can do better and it’s vital for our patients that we do.