Solving for High Speciality Care Costs with Data-Driven Referral Management
Ever-increasing healthcare costs are a challenge for employers and their workforces alike. Specialty care is one of the main drivers of high costs, often compounded by inefficiencies across the industry. The frustration and expense can lead many to avoid seeking the care they need or adhering to recommended treatment plans, which ultimately creates both worse outcomes and even higher costs for everyone involved. And that’s exactly why getting people to the right care at the right time is key to managing costs and outcomes.
At Crossover Health, we approach specialty care needs differently. Referral Management, informed by a combination of proprietary and third-party data, is embedded into our Advanced Primary Care model as part of our Care Navigation services. Our integrated, comprehensive approach has many advantages including:
Up to 30% Cost Savings
Crossover’s Referral Management service is designed to leverage robust provider cost and quality data to deliver high-value referral patterns that result in better outcomes and reduce specialty care costs by up to 30%.
Holistic Care
Crossover looks at the whole person when providing care. That includes social determinants of health (SDOH) like lifestyle, environment, history, and more. Our Referral Management service helps members address SDOH issues by connecting them with community resources and driving awareness of other employee benefits (point solutions) available to them.
Improved Outcomes
As part of Crossover’s Referral Management service, we will proactively close the referral loop for the member. This not only improves the quality of care each member receives, it also makes it simple for them to follow through with getting the specialty care they need when they need it, which results in better health outcomes.
What is Data-Optimized Referral Management?
Crossover’s Referral Management service is designed to connect members to the right care at the right time to improve outcomes and lower costs. To start, we use robust cost and quality data to analyze a proprietary list of high-value specialists to inform all referrals. Then our Care Navigators use this data to find specialists from our directory who provide the highest quality care—adherence to care standards, reduced complications and readmissions—while keeping costs low. This ensures that members get connected with high-quality, cost-effective, in-network specialists and facilities, which allows Crossover to deliver more cost savings and better health outcomes.
It also provides a seamless experience for members by navigating a complex facet of the healthcare system for them. In addition to data-optimized specialist referrals, Care Navigators will help with scheduling appointments, record retrieval and sending, and closing the communication loop between Crossover and community providers for members. And they’ll continue to collect data and provide reporting on specialist referrals and referrals to other point solutions within the benefits ecosystem for clients.
Driving Better Outcomes with Cost-Effective,
Personalized Referrals
Crossover has partnered with Switchboard to enable better-than-ever data-optimized Referral Management. Switchboard’s tool leverages validated, up-to-date data through Care Journey, an industry-leading, national database of provider cost and quality data. Care Journey’s data is based on claims data from 100 million lives, benchmarked across 740K providers. This gives Crossover’s Care Navigators access to a broad data set that enables cost-effective and personalized specialist referrals, resulting in even better health outcomes.
Partnering with Switchboard has a lot of other benefits, as well. Switchboard provides Crossover’s Care Navigators with episode-specific performance data on specialists. This means they can select the best provider for specific procedures like colonoscopies, for example. The tool also equips Care Navigators to quickly become familiar with high-value providers in new markets and respond faster in unfamiliar referral situations. It’s the only tool that lets Crossover’s Care Navigators layer the data they collect on provider responsiveness, patient ratings, patient preferences, location, and network status with robust cost and quality data to create a short list of Crossover-preferred specialists.
All of this translates into data-optimized referrals, powered by Switchboard, that are hyper-personalized for members. And, it supports Crossover’s quality of care standards in a cost-effective manner, improves outcomes, and allows Crossover to deliver greater value to employers at a greater scale than ever before.