Closed Loop Referral Systems

Working in health or social care is rewarding when you see the results of your efforts. Care teams who coordinate closed loop referrals can positively impact thousands of lives.

If you are looking for a closed loop referral system, learn more about NinePatch® sdoh software solutions. Request a demo today.

Closed Loop Referral SDOH Initiatives

Focus on closed loop referrals is increasing. This is due to Medicaid Managed Care programs in some states implementing social determinants of health initiatives.

Sdoh and healthcare initiatives provide a range of services to support vulnerable populations with complex needs. These needs may include mental health, behavioral health, substance abuse, elder care, and disability services. The services provided can be clinical and non-medical or social.

Due to a recent rule issued by CMS, Medicare Advantage programs are embracing health related social needs efforts. CMS Rule 4201-F includes a provision focusing on health equity that describes various initiatives.

NinePatch® Solutions for Closed Loop Referrals

NinePatch Whole Person Care and RiE™ software programs facilitate data transfer, consents, privacy, closed loop referrals, and other one-of-a-kind features.

The second-generation software connects resource directories, HIEs, CIEs, state and county agencies, community-based organizations, health care organizations, tribes, long term care, home health, and other provider organizations.

Closed Loop Referral Systems

SDoH initiatives can be initiated by payers, health systems, or community based organizations to support closed loop referrals across a variety of social and healthcare providers. Payers piloting programs in a single county are extending successful programs across multiple counties and state lines.

Translating social circumstances— documented by assessments that relate to LOINC or z-codes—to health care diagnosis, ICD-10 and CPT codes can support quality measurements required by value based care programs.

However, barriers for interoperability and closed loop referrals exist on both sides of the care continuum. Let’s look at several of the challenges and practical solutions.

Interoperability

Interoperability barriers exist between the software programs of social and healthcare organizations. The benefits of interoperability to improve patient care and reduce costs outweigh the efforts necessary to close these software or technical gaps.

Infrastructure is already established in many communities to support basic interoperability. CIEs (community information exchanges) and HIEs (health insurance exchanges) are part of this infrastructure.

CIEs support access to community resource and client data, as well as create and maintain community governance programs. HIEs transfer patient information between electronic health record systems.

Organizations working within and across states, may use specialized software for care coordination and closed loop referrals. This software may have specific features depending on the organization’s goals. Examples include housing information management systems for the homeless, electronic health record systems for hospitals, clinical note and billing software for behavioral health, and care transition software for home health care.

Social determinants of health initiatives for closed loop referrals combine social services and the provision of health care. For successful implementation, these programs must have a minimum level of interoperability and shared program access.

Are Closed Loop Referral Processes the Same?

Ask social and health care providers for their definition of a closed loop referral process and you will receive varied responses. The definition of closed loop referrals vary because social and health care organizations operate under different organizational and revenue generating structures.

CBOS may rely on grants and funding that may not require extensive documentation of outcomes or results. On the other hand, collecting data is critical for healthcare organizations to prove the impact of their efforts..

Let’s look at several examples of the referral process.

Community-based organization referral

A CBO may initiate a referral by obtaining consent from a client to share their information. A formal intake, screening, or assessment to identify client needs may or may not be required before making the referral.

For example, a staff member shares the client’s information with a transportation company or a food bank. The organization receiving the referral may not confirm receipt of the referral. They may also not provide the service or update the referring organization about the completed activity.

When this happens, the referral loop is not closed. The CBO staff may check off a box saying that they made a referral. Unlike a healthcare organization there may be no requirement to document the result or the outcome of the referral.

Community organizations without access to closed loop referral system can contact NinePatch to learn more about joining an existing referral network or initiating a local Whole Person Care Program.

Closed loop referral within a healthcare system

Let’s look at a closed loop referral for a value based healthcare organization reimbursed for quality of care. Quality of care means that providers must report data measurements related to patient care to payers for specific measurements. These data metrics must demonstrate improvement of risk adjustment factors and other measures.

For example, healthcare organizations must record information about hospital readmissions, adverse events, care coordination, patient engagement, and other activities. So a closed loop referral within a healthcare system may relate to hospitalized patient who is discharged. The discharged patient is scheduled and attends a doctor’s appointment for follow up care to close the loop.

Specialty care closed loop referral

Specialty care referrals can require a higher level of detail. The process to close the loop for a patient referral to a specialist from a primary care physician may include:

• Create an information file for a patient and document needs based on a health assessment
• Discuss the reason for the specialty referral with the patient and obtain consent to share protected health information
• Schedule the specialist appointment
• Obtain pre-authorizations if required
• Electronically transmit patient healthcare records and documentation to support the request for the appointment
• After the patient appointment, the specialist returns information to the referring primary care physician about the result of the interaction

Other examples of specialty care referrals may be a physician’s office who schedules lab work or tests. The practice may desire to schedule and confirm transportation to an appointment or testing location.

Closing the loop may mean receiving confirmation that the patient was transported to the appointment. Additionally the receipt of lab work or a test result can close the loop.

In all of these situations where closed loop referrals are critical, NinePatch Whole Person Care and RIE software solutions offer interoperability and the level of detail necessary to ensure client and patient care. Referrals can be made in minutes instead of hours.

Healthcare to community based organization referral

A physician at a hospital treats and discharges a patient. The hospital discharge planner obtains patient consent. Using the NinePatch Whole Person Care platform a referral is sent to a food bank and a transportation company.

The community staff at these organizations accept referrals and join the care team. They communicate with the client and provide assistance. They also update the hospital discharge planner in the care coordination portal. This is an example of a closed loop referral between a healthcare and social care organization.

Whole Person Care Takes Closed Loop Referrals to the Next Level

So, as you can see, closed loop referrals are defined differently for social and healthcare organizations. A focus on whole person care encourages cross-collaboration between disparate providers. 

The desire to understand of the measurements important to each provider is the path to developing and sustaining broad based community programs. This means eliminating the silos and biases that exist to establish common goals and build cooperation.

At NinePatch, our focus is on collaborating with meeting the needs of our clients in local communities and across states. 

To learn about NinePatch solutions for closed loop referrals, schedule a demo today