5. referral coordinator curriculum - chronic care · pdf file5. referral coordinator...
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Reducing Care Fragmentation 35
5. Referral Coordinator Curriculum
© Copyright 2011, The MacColl Institute for healthcare Innovation, group health Research Institute.
http://www.improvingchroniccare.org
PATienT suPPoRT TOOL REFERENCE
Referral Coordinator CurriculumReferral Coordinator Curriculum
A designated referral coordinator can markedly enhance the efficiency and improve the
experience of patients undergoing referrals or transitions in care. Training for this
position is not widely available, and most practice teams will find they need to provide
training in core competencies. Since the tasks of referral coordinators touch on most
parts of health care delivery, and focus on connecting them, a working knowledge of
several domains is necessary:
Primary care delivery and medical records
Developing and sustaining relationships with community providers and agencies
Insurance and finance structures
Communicating effectively with patients and families
IT system or other tracking method for information transfer and monitoring
The following table provides basic competencies and content for referral coordinator
training.
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Understanding of
job’s purpose
What are high‐
quality referrals and
transitions and why
are they important?
Define referral and transitions.
Describe why high‐quality referrals and
transitions are important.
o Discuss differences between
Ms. G and Ms. H.
o Read introduction of toolkit and
description of Care
Coordination Model.
Discuss high‐quality referrals and
transitions.
Team work How is the Referral
Coordinator
expected to work
within the health
care team?
Include clinical lead(s).
Discuss types of questions that Referral
Coordinator should ask of the (1) patient’s
provider or (2) agency to which the patient
is being referred to.
Discuss how Referral Coordinator should
ask these questions (via weekly meetings,
post‐it notes on charts, e‐mail, etc.).
If practice has or will be developing
guidelines: review guidelines with Referral
Coordinator using patient cases.
Be liaison with
“outside” agencies
With whom should
the Referral
Coordinator develop
relationships?
Identify key community resources that
patients frequent.
Discuss the importance of (ongoing)
outreach to these groups.
o Read Genesys Case Study from
toolkit.
Discuss relationship building with
appointment clerks at specialist offices and
hospitals.
Utilize e‐referral or
tracking system
How does the
Referral Coordinator
use the e‐referral or
tracking system?
System is for all patients who are being
referred or transitioning between health
care settings.
Goals are to request referrals, facilitate
appointment making, transfer appropriate
information and provide population
management of this group so that patients
have a high‐quality referral/transition.
Goals can be met using structured forms, a
database using excel or access, or by an
electronic referral system.
Systematically assemble each patient’s
information needs for referral/transition
including:
o Demographics
o Insurance information
o Pertinent medical information
for referral/transition
o Information the patient needs
about referral such as
directions, appointment
scheduling, any other
expectations
o Any logistical barriers/needs
that the patient has
(interpreter, transportation,
etc.)
Understand medical
chart
How does the
practice organize
their medical charts?
Referral Coordinators who are new to the
practice need to understand how medical
charts are organized, and how to find
information for referral.
Have medical records personnel provide
training.
Understand insurance
process
What administrative
tasks need to be
accomplished to
assure insurance
authorization and
coverage?
Referral Coordinators may also need
training on the insurance tasks of the
practice.
Have appropriate staff person provide
training.
Provide patient
support
What barriers and
problems do
patients face when
referred to a
specialist or
community agency,
or when discharged
from the hospital or
ER?
How can these
problems be elicited,
and what actions
might the
coordinator take to
remedy them?
Review problems in referrals and care
transitions using case examples.
Provide training and role play experience
for interactions with patients and staff of
outside providers to resolve problems.
Use the e‐referral or tracking system to
identify problems in the referral process.
Provide training and role play experience
for interactions with patients and staff of
outside providers to resolve problems.