Presbyterian Hospital in Downtown Albuquerque. The health system’s insurance arm, Presbyterian Health Plan, has partnered with a national software company to promote a new closed-loop referral system aimed at helping New Mexicans find the resources they need.
Presbyterian Health Plan, the insurance arm of Presbyterian Healthcare Services, has partnered with national software company Unite Us to bolster its newly created closed-loop referral system, an effort aimed at helping New Mexicans find the resources they need.
Those resources span outside of the health care realm, said Megan Moore, PHS’ executive director for population health, to include areas such as transportation, access to food and housing.
“We know from research that only about 20% of health outcomes are really driven by the medical care you receive once you’re inside an office — or the surgery that you receive, or the drugs. So much of it is the environment you’re living in, your access to food, whether you have access to safe places to exercise — all of those things,” Moore said. “So if we’re interested in the outcome, we have to address 80% of the root cause. And I think health care is increasingly being asked to address those things. But it also just naturally makes sense, given our mission.
Moore said PHP sees its goal in addressing disparities in the community as “long term,” adding that the health insurer has already identified six counties — including Taos and Doña Ana — where it is implementing the closed-loop referral system to better serve those populations.
The closed-loop referral system, Moore said, allows Presbyterian and its partners to screen patients for social determinants of health and provide a tailored list of resources to those individuals who are in need. Even more, the Unite Us platform allows organizations like PHP to send electronic HIPAA-compliant referrals to its partners, where it can then also see that a request — like transportation — was fulfilled.
The Unite Us platform also allows PHS partners in the closed-loop referral system — it has 231 community-based organizations participating — to refer clients, or patients, to other partners to address the needs of the community.
Moore describes the closed-loop referral system as “agnostic insurance.”
“Just because you got the license through Presbyterian Health Plan, doesn’t mean you can only screen and refer members of Presbyterian Health Plan,” she said. “If an uninsured person comes in, or if a person is insured by Blue Cross (and) Blue Shield… it doesn’t matter. We’re trying to provide a tool to the community that can serve everyone.”