Support for community-based population health initiatives has been growing and governments and grant-giving agencies are accelerating their investments. For example, Canada’s Intersectoral Action Fund and the Center for Disease Control’s Social Determinants of Health provide supportive grants. The awarded local lead agency will inevitably be charged with building trust, data sharing and creating cross agency referral relationships, or “networks”.  Demonstrating success to the funder will require monitoring the health of the referral ecosystem.

Volume of referrals, over time, does not tell the whole story. There are usually multiple channels of access that need to be monitored and important metrics associated with each. Monitoring the right metrics can help lead agencies have trust that all the partners are providing optimal person centred care.  

Referral Outcomes

Nobody likes a mystery, particularly when it comes to healthcare referrals. If a client requests service, or a clinician sends a referral, you want to know they were helped. Every referral should have an outcome whereby the service provider indicates what happened. Did they speak to the client? If so, when? Were they admitted, rejected, or waitlisted? When every referral is tracked, the network administrator has the opportunity to understand patterns of service delivery across the region. When referrals are not tracked, the health of the referral ecosystem is undiagnosed. 

Goal: Percentage of network referrals with outcomes shared = 100%

Once referral outcomes are monitored, the network administrator can begin to understand patterns. For example, are there some services or regions with longer wait times? This might be a signal that new partners should be added to the network, or that additional service investments are required. Are providers frequently indicating that clients are ineligible for service? This may indicate that the service is poorly described in the first place and needs to be clarified. Are clients frequently not arriving for the intake appointment? Perhaps it is time to activate email or text appointment reminder notifications. Ideally, every referral leads to a timely admission to service.   

User Experience 

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We have all seen these questions, and when we answer, we are helping a business gather valuable customer experience insights. This is called the Net Promoter Score (NPS), where the algorithm produces a user experience score between -100 and +100. It is a particularly great measurement tool precisely because it is used so often; there are many companies with whom you can benchmark. For perspective, here are some average scores across different industries and companies:

• Facebook: -21
• FedEx: +3
• Healthcare companies: +27
• Software companies: +30
• Starbucks: +77

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Caredove is able to provide network administrators with the net promoter score of their network. This will provide you specific insights into your clients’ experiences accessing service in the network. If they experience unresponsiveness, unclear processes or unbookable services, your NPS will drop. 

Benchmark your network’s NPS against Caredove’s platform wide average of 74 to understand how well your network is performing in terms of user experience. 

Website Metrics

If public access is a key referral channel, understanding your website’s performance can be a helpful tool to monitor the health of your network. Website analytics can provide you with statistics for the number of visitors to your website, where they came from and what they did while they were there. If you notice that you have a high volume of traffic leaving the site after a short period of time without booking a referral, it may benefit you to consider how you can change the flow of your website to make this process easier for potential clients. 

Important website analytics to monitor include:

• Conversions: A conversion occurs when a visitor to your website completes a desired goal. In the case of a network, this goal is likely a referral being transacted. Keeping an eye on the conversion rate of your website’s visitors is essential to ensuring the public facing side of your network is functioning well and can provide insights on where to make improvements. 
• Pageview: A simple but powerful metric, a pageview is counted when a user visits any page on your website. This allows you to see which content is being seen most often. If your primary call to action is hidden on a page that nobody is visiting, you are unlikely to get conversions.
• Bounce Rate: This is the percentage of user sessions with a single pageview. This provides top-level insight on how your network website’s content is performing, particularly if your client’s journey should involve them visiting a subsequent page in order to connect to a service. This metric is less relevant on a single page website where all the information, including your call to action, is provided on one page. 
• Source: Reporting and analyzing how people found your website is important to understanding which channels are most effective at driving leads and growing referrals. If none of your traffic is coming from your network member’s websites, then you might have an opportunity to engage them in link building and cross-advertising to drive further growth. 
• Average Session Duration: This metric provides a top-level view of how long users spend on your website, and can be a good indicator of whether or not your customers are digesting the information provided. If most sessions are short, your message may need to be condensed to get your point across and increase conversions. 

Providing your partner organizations, funders and stakeholders with a full picture of your network health will help influence decisions for the future of your network. Keep a close eye on these metrics and make small adjustments throughout the year to measure continued success across your network.

Client Reported Outcomes (CRO)

Once a client has been referred or signed up from a website, how do you know if the service actually helped? You could have a great referral process to a very unhelpful service. How would you know? Basic surveys of service experience conducted manually are common, and a good place to start. Administering these automatically by using a referral management system at predetermined intervals is next level. Ambitious network administrators can roll out something called a Client Reported Outcome (CRO) at a regional level, as a way to identify strengths and weaknesses in the network. A CRO (also known as a Patient Reported Outcome, or PRO) is a health outcome reported by the client themselves. 

CROs evaluate one or more aspects of health. This could be physical, mental or social health in adults or children. They can be used in the general population or by people living with any chronic disease. Typically, a questionnaire is created that assesses the health status or symptoms, like pain. There is a burgeoning list of validated tools available, like what is shared by the Canada PRO initiative or the National Institutes of Health.  

CROs also provide valuable insights to funders and network leadership. If you are running a pilot program to test a new service access process in a region, funders will want to know how the clients felt about the ease of accessing services and transitioning through various stages of care. If a client found it significantly easier to connect with care and achieve positive self-reported health outcomes, there is a high chance of your pilot program turning into a sustained regional network. 

Referral management systems are optimally positioned to track CROs before and after service has started. This provides network administrators an understanding of the impact of services across the network, from a client perspective.  

Collecting metrics and analytics on all aspects of your network’s health will help provide network leaders, funders, referrers and clients with confidence that your network is successful in providing timely access to quality services. Continue to monitor your network’s health on a regular basis to find ways to improve user experiences and streamlined intake processes.