With the promise of rapid communications capability and new technological tools, it should be easier than ever to make sure the client we’re referring to another organization for services actually receives them. Yet we’d wager anyone who attempts to operate in closed-loop referrals has their own list of limitations. Our recent Nexus Connect project provided screening and referral for health-related social needs for under-resourced residents in two Montgomery County ZIP codes through funding from the Maryland Community Health Resources Commission (CHRC).* It also inspired thought on the caveats we recommend for like-minded efforts.
Are you measuring service receipt or referral follow-ups? A study of patients referred to social services by North Carolina hospitals explored the correlation between closed referral loops and documented receipt of services. It found some significant discrepancies. Part of that finding is because the definition of a “closed” loop included clients who didn’t want or couldn’t receive services, in addition to clients who had only submitted assistance applications. Ultimately, closed loops were very high—93%-99% in the two periods of study—while service receipt was substantially lower—as high as 65% in the period with dedicated social service funding and less than 40% in the period with lower service investment. Administrative loop closure is an important process evaluation measure, but service loop closure is key for assessing impact.
In the last decade, we’ve seen multiple attempts to grow online referral tracking mechanisms. Two of the commercial options we have used at PCC are FindHelp and Unite Us. Both provide tools to find local resources, refer individual clients to social services in the community, and follow results as part of case management. These systems can circumvent many rounds of phone tag trying to get updates on referral status, but they require collaborative investment to work well:
- Peak day-to-day effectiveness requires alignment around a single platform. Otherwise, case managers are replacing multiple phone calls with logging into multiple systems and—potentially—trying to extract data for their own records maintenance. Time saved: some. Sanity saved: negligible.
- Adopting these systems will require financial and/or operational resources. Organizations operating as a case management “hub” may need to invest in a paid model for comprehensive data tracking and reporting. Organizations making and receiving referrals will need to evaluate their program workflows, including when and how they currently manage client information, to understand which elements referral management software can replace. It is likely easier to incentivize this workflow change when there is an indefinite partnership commitment, as opposed to time-limited grant funding. On the other hand, organizations piloting those collaboration tools will likely need to rely on time-limited funding for proof-of-concept. A recent North Carolina study found substantial differences in the rate of service receipt following a referral when there was dedicated funding support for both the closed-loop platform and the community-based services, concluding that “successful integration of medical and social care will require financial support for resources and infrastructure.”
What do these caveats mean for adopting a realistic outlook on future multi-partner case management programs? Think carefully about outcome expectations and program staffing.
There is so much promise in the technological tools we have, but they are not (completely) magic. Successful systems will still have to align them with people and process.
*Supported by the Maryland Community Health Resources Commission. The views presented here are those of the author and not necessarily those of the Commission, its Commissioners, or its staff.
- Expectations: Anticipate losing touch with at least 40-60% of clients referred, either because they could not be reached or didn’t want to be.
- Program staffing: Assume some portion of the project will require manual data cleaning and analysis, as well as some dedicated problem-solving around the data setup process. These tasks require program manager participation but may be beyond a program manager’s expertise. Anticipate needing some dedicated time from a data analyst and investing in paid tiers of case management platforms—then be sure those needs are included in the program budget.
There is so much promise in the technological tools we have, but they are not (completely) magic. Successful systems will still have to align them with people and process.
*Supported by the Maryland Community Health Resources Commission. The views presented here are those of the author and not necessarily those of the Commission, its Commissioners, or its staff.
RSS Feed