Leakage – The Problem & A Novel Solution

Nearly one in five executives report losing more than 20% on patient leakage annually.

More than four out of five healthcare executives report that patient leakage is a serious problem facing their organizations, though very few have implemented solutions to stop it, according to a new survey from Fibroblast, commissioned from Sage Growth Partners.

Patient leakage happens when a patient receives a referral say for knee surgery and that patient ends up going to see a specialist outside of the health system network where the patient received that referral. As most of us know, this happens all the time because as patients we want to seek the best care and we usually research and evaluate our options, especially when we are referred to specialists from our PCP’s. For example, when I hurt my knee about 15 years ago and was referred to an orthopedic surgeon, my first reaction was to research his bio and then to ask others who had the same injury what doctor they used and how their experience was. After all, we all want the best care and best outcome. Hence, it is plain to see that patient leakage is not any easy problem to prevent.

The other way that patients are often referred outside of their PCP’s network is when doctors have established relationships with certain specialists they know and trust, but they don’t realize that they are outside of their network. Essentially, in this case doctors are giving away money. This case is definitely preventable and can of course be measured.

Some interesting data points from the survey:

Who's Aware of Patient Leakage:

• 87% of executives say it's a high priority
• 23% don't track it
• 20% don't know where or why it happens

Just over one-third of polled executives reported that they understand where and why patient leakage occurs, with 60% saying they don't follow up with patients to determine if they received care from the physician they were referred to.

What Patient Leakage Costs Annually:

• 43% of executives say they've lost 10% or more of revenues
• 23% say they don't know how much they're losing
• 19% say they've lost 20% or more

As vexing this problem is for healthcare executives, systems and even payor, there is a solution. It starts with identifying the problem and understanding the source of it. Obviously it rests in the referral process and changes need to be made. Here are a few that are proven to minimize it:

1. Make it a strategic precedence from the top down & have a team accountable.
2. Utilize & implement a data-driven approach to measure it.
3. Understand your referral patterns.
4. Improve care-coordination so referrals only provide in-network options.
5. Measure effectiveness of changes, refine if needed & stay on top of it.

There are of course fantastic AI solutions that help with this issue like MayaMD. If you would like to learn more about it, let us know.

‍