Our last two blogs discussed the current state of referral metrics and the changes needed to optimize these metrics going forward. Now we will discuss the necessary data requirements for further improving the quality of care. While navigation systems track a breadth of data metrics, several untracked variables remain integral to the improvement of care. This blog advocates for three groups of outcome measures needed to assess the efficacy of referral networks.
The publication, “Mapping the Navigation Systems of Pennsylvania: Opportunities for the Future,” summarizes three metrics that would optimize network management and cost savings: closed-loop referral data, government-tracked service utilization data, and cost of care data.
- Closed-loop referral data
A next step for the metrics of navigation systems is the gathering and usage of closed-loop referral data. Closed-loop referral data track the outcome of referrals for clients and how well providers performed their role. In order to gather this information, navigation systems automatically report outcomes for both clients and providers. Closed-loop referral metrics include whether the client received care, how quickly they received that care, how accurate the first referral was in achieving care, and in some cases, pulse-point surveys of clients to determine their satisfaction with the care that they received.
Some important information that this metric would provide:
- Provider responsiveness
- Accuracy of referrals
- Which clients receive services after making a request.
A number of navigation systems claim to offer closed-loop referrals. However, none of these systems provide these measures for all of the cases. Some systems allow providers to opt-in to providing these metrics, making the data incomplete. Others allow human navigators to close cases when they refer to “out of network” providers, making the outcomes of these “shadow network” referrals invisible. Complete closed-loop referral data would inform navigation systems on how to adjust their practices to increase the likelihood of complete and holistic care.
- County and state government-tracked service utilization data
Within the current referral landscape, most navigation systems are privately run entities. While privately run navigation systems can track clients who have contacted them and their outcomes in the short term, public data is needed to gain insight into the impact of these systems on public health and community wellness. For example, private navigation systems are tracking their own clients, but what about individuals in need who are not contacting a navigation system? What about clients who are working with multiple navigation systems?
These questions could be answered through state and county government-tracked utilization data. This data would include longitudinal data on public sector service utilization and interaction. This would allow navigation systems to compare the outcomes of referral network clients and similar individuals that do not use the system. It would also allow them to track outcomes for clients longitudinally after their service episode is closed. Finally, public data allows navigation systems to determine which types of clients they are not reaching, and to develop more targeted outreach programs to support the early stages of the help-seeking process.
Some important information that this metric would provide:
- Individuals in need who are not contacting navigation systems
- Comparing clients with individuals who use other navigation systems or that apply for various benefits
- The long-term impact of navigation beyond the service episode
The purpose of navigation systems is to help all those in need of care. Care involves more than just clients seeking out some specific navigation system. It consists of the public as a whole: those seeking care from one platform, those seeking care from a different platform, those seeking care from several platforms, and those not actively seeking the care they need at all. State and county government-tracked service utilization data could help navigation systems approach the larger care needs of the community. Furthermore, this public data could be used to aid predictive analytics that prompt navigators to reach out to clients before they ask for help.
- Cost of care data
Finally, many navigation systems lack information on their return on investment. In order to determine whether navigation systems are worth the cost, data is needed to calculate the cost of care of clients across benefit programs. This data would track the medical and human service costs of navigation system clients, in comparison to a similar group of clients that do not receive navigation assistance. Insurers, especially those that manage Medicaid and Medicare, would need to partner with state and county governments to create such a dataset.
Some important information that this metric would provide:
- Cost benefits of navigation systems
- What specifically is resulting in cost benefits
- How to correct practices to optimize and expand cost benefits
Navigation systems work to prevent acute or chronic needs. Preventing these needs is likely more cost-effective than remedying these needs. If this is the case, this metric could be a significant indicator that navigation systems are worth the resources.
These three future data practices, closed-loop care data, government-tracked utilization data, and cost of care data, are essential for the next wave of innovation in health and human service referral networks. Data is more than numbers; it is tangible information that navigation systems can use to adapt, improve, and optimize practices. With better practices, we get better navigation systems, and with better navigation systems, we get better care. And, care is the goal.