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Engaging patients more in their own care, which is that whole shared-responsibility piece […] how do we actually have a system that helps [them] be more involved and also ensures that there are supports in the system. Because the system is so darn confusing, you can’t leave people out there trying to navigate it on their own. (Jackson et al., 2017, p. 43)
Introduction
A severe threat to continuity of care is patient referral leakage; “leakage,” a term used to describe patients who are referred to or seek out-of-network[1] health-care providers, affects the patient, the referring physician, the consulting physician and the organization. To understand how leakage manifests in other service contexts, consider the “leaky bucket” analogy used in relationship marketing. Imagine a bucket filled with water that, unfortunately, has several holes in its base and sides. If the total amount of water represents the size of the customer base, then there are two strategies to maximize volume. A business can find new sources of water (new customers) or focus on plugging the holes to avoid water leaking out (customer retention). This analogy is often used to describe the differences between transactional and relational marketing approaches (O’Malley and Tynan, 2001) and illustrates how unsustainable leakage can be. Like other businesses, leakage in health care is costly and risky. According to Referral MD (2018, 2019), a health-care management referral service, the average annual referral leakage can account for 55-65 per cent of lost revenue, resulting in a loss for a hospital of approximately $821,000-$971,000 per physician. Leakage costs health-care organizations an average of 10-20 per cent of annual revenues (Sage Growth Partners, 2018; LaPointe, 2018). Leakage also contributes to waste in health-care spending. Of the six categories of health-care waste identified by the Institute of Medicine, leakage is included in two costly domains – care delivery and coordination. Such waste burdens countries, such as the USA, with an estimated annual cost from $129.6bn to $243.9bn (Shrank et al., 2019).
At the network level, both financial and clinical control of the patient’s care is lost (Referral MD, 2019). Leakage also disrupts continuity of care – resulting in greater errors and adverse events for everyone involved (Jackson et al., 2017). Unfortunately, most health-care C-suite executives...