Referral management is defined as the management of the procedure by which patients move on to the subsequent phase of their care. This adjustment typically takes place when a patient’s condition is at its most vulnerable during an increase in treatment or a change in diagnosis.
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Referral management typically occurs when a primary care physician refers a patient to a specialist, but it can also take place when a patient is transferred from an inpatient facility or emergency room to another specialist or to a provider.
Enhancing and streamlining communication between primary care physicians, specialists, and other healthcare providers is the main goal of the referral management system. Modern healthcare is geared toward maximizing quality and effectiveness while lowering costs. The entire sector is adjusting to the use of technology to streamline administrative processes. The widespread use of electronic medical record software in hospitals and clinics across the country is proof of this.
A step in the right direction has been made with the transition to a more standardized and organized approach to documenting and caregiving. When these highly acclaimed Electronic medical records (EMRs) are accompanied by a patient’s health insurance or any other health care that they might have, they provide all necessary information to the doctor. This enables both, the doctor and the patient to choose the best method to cure the problem. EMRs are often found by organizations to be insufficient for managing and monitoring referrals.
When health systems have referring clinicians who utilize multiple EMRs or are coordinating treatment between employed and independent doctors, referral management becomes especially crucial. It also finds usage in the management of one or more value-based plans by health systems. Referral management systems aim to enhance patient accessibility and appointment scheduling functionality as well. Their widespread use is also valued when health systems build and oversee a high-performance network of experts.
COVID-19 Impact Analysis
The healthcare systems around the world were not able to handle the COVID-19 crisis. As it was an unforeseen, significant health issue that demanded an immediate mobilization of resources and impacted the entire population. The pandemic contrasted sharply with the path that healthcare systems, especially in affluent nations, have been heading in recent years. Rather than having any positive or negative effects, the pandemic facilitated the downfall of the overall healthcare structure in many countries. The inconsistent health care industry realized the importance of proper patient management during the pandemic.
Market Growth Factors
Provision Of Inclusion Of Referral Management In Healthcare By Government
A comprehensive range of public health services, such as medical, dental, behavioral, and other patient care, are offered by government organizations, including those at the federal, state, county, and many municipalities. These services, which can be significant in large urban areas, are operable in public hospitals, clinics, nursing homes, and treatment facilities in addition to offering health insurance. Usually, smaller public health agencies provide fewer services. Regardless of the size and scope of the business, the governments recognize that the services provided are crucial for the well-being of the patient population they serve.
Ease Of Access And Understanding With Automation Of Referrals
Referral programs become harder for people to refer to someone else if they come with too many steps. The manual method often has lower success rates as well. The introduction of automation, along with other significant technology inclusion, has made referral a one-step process. The other benefit of automation and technological inclusion in referral management includes time utilization, improved patient access, and quality patient time. Improvements in patient access are another advantage of the referral management system. The technology allows patients to make appointments based on their availability and the specialist’s availability.
Market Restraining Factors
Lack Of Skilled Healthcare Information Management Professionals
Gaps in program execution are caused by the lack of sufficient IT professionals in the healthcare sector, particularly among healthcare providers. Utilizing technology-integrated solutions effectively necessitates a solid IT infrastructure and assistance both inside the firm and from the solution vendor. In healthcare businesses, there is a constant need for technical assistance to maintain the server and network. A very specific skill set is needed to merge knowledge of internal medicine, healthcare insurance, business, and information technology.
Based on the component, the referral management market is bifurcated into software and services. The services segment procured a significant revenue share in the referral management market in 2021. The referral management services are getting better with each passing day. So patients, who do not have referral management from their providers, choose one themselves. The referral management services usually have third-party characteristics.
On the basis of type, the referral management market is segmented into inbound referrals and outbound referrals. The inbound type segment dominated the referral management market with the largest revenue share in 2021. The huge amount of inbound referrals that hospitals and specialty centers receive from various channels is what is causing this category to rise. A patient does not have to establish credibility and validate assumptions when using an inbound referral.
Mode Of Delivery Outlook
Based on mode of delivery, the referral management market is categorized into cloud-based and on-premise. The cloud-based segment dominated the referral management market with the highest revenue share in 2021. Due to the advantages of cloud-based solutions, such as on-demand self-serving analytics, no upfront capital investment for hardware, and extreme capacity flexibility, among others, their strong growth rate in this market can be credited.
End User Outlook
On the basis of end user, the referral management market is divided into providers, payers, and other end users. The payer segment procured a substantial revenue share in the referral management market in 2021. Healthcare payers who are in charge of managing the treatment of their insured population want to see that patients receive the recommended care as soon as possible.
Based on region, the referral management market is analyzed across North America, Europe, Asia Pacific, and LAMEA. The North American region dominated the referral management market with the maximum revenue share in 2021. Most health insurance providers as well as healthcare providers have already accepted referral management as an integral part of healthcare. The way these work efficiently to save time for patients and providers has also gained support for the referral management systems.
The major strategies followed by the market participants are Partnerships. Based on the Analysis presented in the Cardinal matrix; Oracle Corporation (Cerner Corporation) and UnitedHealth Group, Inc. (Optum, Inc.) are the forerunners in the Referral Management Market. Companies such as GetWellNetwork, Inc., Cloudmed (R1 RCM, Inc.), CarePort Health (WellSky Corporation) are some of the key innovators in Referral Management Market.
The market research report covers the analysis of key stake holders of the market. Key companies profiled in the report include GetWellNetwork, Inc., Epic Systems Corporation, Oracle Corporation (Cerner Corporation), CarePort Health (WellSky Corporation), eHealth Technologies, Inc., UnitedHealth Group, Inc. (Optum, Inc.), Persistent Systems Limited, Cloudmed (R1 RCM, Inc.), EcoSoft Health, and ReferWell.
Recent Strategies Deployed in Referral Management Market
Partnership, Collaborations and Agreements:
Oct-2021: Optum collaborated with SSM Health, a non-profit United States health care system. This collaboration focused on making quality care more accessible and affordable for people across the Midwest. Additionally, the organizations aimed to improve the overall well-being of individuals and communities while addressing the complex social and economic factors affecting each person’s health.
Sep-2021: Epic Systems Corporation partnered with Walmart, an American multinational retail corporation. Under this partnership, Walmart focused on using Epic’s electronic health records in its health centers. In addition, Walmart also stated that the Epic system complemented their omnichannel health care offerings by letting customers and healthcare professionals access care and health records to lead to more personalized care.
Aug-2021: ReferWell partnered with Healthmine, a technology-enabled member engagement, and rewards company. The partnership aimed to help in simplifying member journeys by delivering personalized health action plans that identified the most critical gaps in care and scheduled necessary provider visits, all within the same application. This resulted in improved care coordination and effective management of care transitions.
Aug-2021: CarePort, powered by WellSky, partnered with Coalition of Asian-American Independent Practices Association (CAIPA). Under this partnership, CAIPA aimed at improving coordinated care, driving improved patient outcomes, and achieving operational efficiencies for providers. In addition, CAIPA selected CarePort Connect to manage patients across care settings through real-time data and alerts.
Jul-2021: Cerner Corporation collaborated with El Centro Regional Medical Center (ECRMC), an American acute-care medical center. This collaboration aimed at ensuring the highest standard of care for patients as well as the ability for them to have access to their medical team and records at their fingertips. It also assisted their clinicians with vital information access.
Apr-2021: CarePort came into partnership with ExactCare, a national healthcare services company, and the pharmacy provider. This partnership equipped hospitals and health systems with high-touch, comprehensive medication management and pharmacy care services for high-risk patients with complex needs and chronic conditions through transitions of care and into their homes.
Mar-2021: Epic Systems Corporation collaborated with Humana, an American health insurance company. This collaboration aimed to help in the completion of the first stage of a joint effort to improve patient, provider, and health plans. This also focused on reducing the administrative burden in healthcare by securely exchanging information between providers and the health plan.
Aug-2020: Cerner Corporation partnered with Xealth, the leader in enabling digital health at scale. Through this partnership, Xealth and Cerner aimed to give patients their own digital data so they can be more engaged in their treatment plans. The Xealth platform was designed to help clinicians easily integrate, prescribe, and monitor digital health tools for patients from one location in the EHR.
Product Launches and Product Expansions:
Mar-2022: Get Well Network expanded its product range by introducing its Digital Engagement Solution to Payers to Close Care Gaps and Improve Retention. This product expansion included four core uses which are Digital member navigation, Member experience, care gap closure, Digital care management, and Vulnerable population engagement. This product is available in the company’s commercial health plans, at-risk providers, Medicare Advantage health plans, and Medicaid managed care organizations.
Oct-2021: Cerner Corporation launched Cerner RevElate, the company’s go-forward patient accounting product. This launch would bring new and enhanced capabilities to the Cerner revenue cycle management portfolio. In addition, Cerner RevElate is the result of Cerner’s investment in advancing patient accounting capabilities and enterprise-wide technology optimization, which is an effort to best-align Cerner’s powerful research and development resources with those solutions most needed by caregivers around the globe.
Aug-2020: ReferWell launched ReferWell software along with Bluestream Health. This launch incorporated care transition management and telehealth capabilities from both companies. ReferWell software lets providers schedule appointments, share clinical notes, and track patient encounters in an EMR-agnostic way. The new solution would improve patient access and experience & increased provider revenue.
Acquisitions and Mergers:
Dec-2021: Cloudmed acquired par8o, an innovative healthcare technology company specializing in 340B and patient referral management technology for healthcare providers. This acquisition would advance the capabilities of Cloudmed’s 340B Discovery Services and elevate its CloudmedAI platform with par8o’s sophisticated machine learning technology.
Oct-2021: Cloudmed took over Eligibill, a leading provider of insurance discovery services for hospitals and healthcare systems. Through this acquisition, Cloudmed helped healthcare providers to recover more revenue and reimbursement across the entire revenue cycle.
Jan-2021: Get Well Network acquired Docent Health, an innovative enterprise consumer engagement platform. This acquisition aimed at creating a next-generation platform for patient outcomes and loyalty. Combined with Get Well Network’s library of 230+ digital care, the consumer engagement platform enabled healthcare organizations to scale personalized outreach through AI-enabled communication technology.
Scope of the Study
Market Segments covered in the Report:
• Inbound Referrals
• Outbound Referrals
By Mode of Delivery
By End User
• North America
o Rest of North America
o Rest of Europe
• Asia Pacific
o South Korea
o Rest of Asia Pacific
o Saudi Arabia
o South Africa
o Rest of LAMEA
• GetWellNetwork, Inc.
• Epic Systems Corporation
• Oracle Corporation (Cerner Corporation)
• CarePort Health (WellSky Corporation)
• eHealth Technologies, Inc.
• UnitedHealth Group, Inc. (Optum, Inc.)
• Persistent Systems Limited
• Cloudmed (R1 RCM, Inc.)
• EcoSoft Health
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