Evolving Epic referral management
and creating value for patients

Dave Moen, M.D., president, Fairview Physician Associates Moen_David_headshot

Earlier this summer a group of independent specialty physicians approached Fairview leaders with concerns about Fairview’s approach to referral management within the Epic electronic health record system. The discussion surfaced several issues affecting our ability to establish the trust needed to create value for patients across the network. In the interest of transparency, I’d like to review that discussion here.

Our approach to referrals must evolve to create new value for patients. The market is moving to increased transparency of price and quality of all our services. This evolution requires that we work together to balance the business interests of Fairview Medical Group, University of Minnesota Physicians and independent community physicians. Along with this balance, we need to address the current pricing strategy for hospital-based services to support our goal to build a sustainable, high quality clinically integrated network. We all recognize there are disconnects between where we are today and where we need to be to meet our goals. The Epic drop down menu is one of many areas that require increased physician involvement.

Epic drop down menu: “preferred” groups
Today the Epic drop down menu within Fairview Medical Group (FMG) includes all members of Fairview Health Network. Menu categories include one labeled “preferred” and one labeled “other.” The preferred group includes all specialists employed by FMG and University of Minnesota Physicians who have practice service agreements or who perform clinical or diagnostic services within Fairview-owned clinics. What most community physicians don't realize is that Fairview owns most UMPhysicians clinics. UMPhysicians is contracted to manage many of those clinics. This relationship affords a hospital-based billing strategy used by most major health systems to fund care provided in specialty clinics. That revenue and hospital revenue at the University of Minnesota Medical Center support funds flow for training students and residents and a research capability at the University of Minnesota.”

This arrangement is not perfect. I recognize that it has not satisfied our University of Minnesota Physician colleagues, nor does it satisfy independent physician colleagues. It does help support the economics of FMG and Fairview, much like those independent network practices that keep more profitable diagnostic revenue within their own groups when possible. This Epic configuration will change as the business model and our network strategy evolve. Our referral strategy will migrate toward those who commit to creating value and who demonstrate that ability.

Physician engagement is key
We recognize that our approach to the Epic drop down list and other referral management practices must evolve to create new value for patients. We also recognize the challenge to strike appropriate balance between creating value and supporting the short-term financial stability of our partners. Resolving this difficult challenge is a priority for 2012. We’ve already begun to tackle that work within the Fairview Physician Associates Product Development and Contracting (PD&C) committee. Our work includes developing referral principles and challenging the current dysfunctional pricing structure, used not only at Fairview but at other hospital systems. We are building the capabilities to exchange information necessary to understand where value is being created to support our overall performance.

You have my commitment to work with you to build a referral management system that creates the best value for patients. In turn, I look to you and challenge you to engage with me to resolve this challenge.

I welcome your feedback. Please contact me at; 612-672-6728.

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