Advancing Your Organization’s Communication Tools for Greater Team Productivity
  • 3 Ways Your Care Team Will Always Have Real-Time Patient Status
  • 3 Ways to Improve Care Team Productivity During the Referral Process
  • 5 Actionable Solutions to Improve Clinical Communications with Your Referral Partners

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The Case for Collaboration

How Does Collaborative Clinical Communication Maximize Outcomes, Higher Patient Satisfaction, and Increased Staff Retention?

Clinical communication and collaboration, referred to as CC&C, is used to define capabilities that allow providers and clinicians to communicate securely in real time.

While this phrase is becoming a hot topic across all of healthcare, it’s important to understand that CC&C is more than just a trendy acronym. It’s a critical component to maximizing outcomes, clinician and patient satisfaction, and efficiency, especially in home-based care.

Organizations that use clinical communication and collaboration solutions experience more positive patient outcomes, higher patient satisfaction, and increased staff retention.

Can Your Care Team Get Real-Time Updates on Patient Status During Their Care Journey?

Home-Based Providers Can Experience This Challenge: It’s not unusual to arrive at a patient’s home and not have information about the previous clinician’s visit. Has there been any updated orders? What else needs to be coordinated amongst therapists, et cetera?

How Can Providers Stay Up to Date in Real-time and Save Time? Communicating seamlessly begins at the start of care, allowing care teams to stay up to date on patient statuses—and patient discussion groups (PDGs) are the most ideal way to achieve this level of collaboration. It’s an automated flow of information, giving care teams consistent updates on patient status and needs.

3 Ways Your Care Team Will Always Know About a Patient’s Status

  1. PDG: Referral to Discharge: From referral to discharge, the PDG is an effective way to share information about the patient and their families. During the referral, the care can upload any documentation needed into the PDG. As the patient moves through to admission, updates to the patient’s care can be documented to keep the care team appraised.
  2. PDG: Real-Time Patient Updates: With PDGs, any updates made to the discussion thread are in real time. This means there are no delays in patient information reaching care team staff and there’s no more reliance on email and phone calls to communicate internally about patient care.
  3. PDG: Care Team Coordination: Through patient discussion groups (PDGs), care partners can easily loop in pharmacists, DME suppliers, and others in real time so they know exactly what needs to be done.
3 Ways to Improve Care Team Productivity During the Referral Process

Advancing Your Organization’s Communication Tools for Greater Team Productivity

Home-Based Providers Can Experience This Challenge: Communication methods to get information from referral sources to initiate and complete a discharge plan are sometimes dated and manual.

Fax is often used to get demographic and supporting documentation that meet payor criteria to their office, multiple phone calls are needed to follow up to make sure the fax is received, education often happens at the bedside, paperwork must be signed in person, and many texts and emails for everything in between.

How Can Home-Based Care Providers Streamline Their Referral Process?

  1. Initiate Patient Discussion Groups (PDGs): With permissions from the care team, start discussions about care, which is saved to the patient record. The referral liaison, account executive, billing, and admissions—anyone with the correct role—can access these chats and communicate what they need all in one place. It’s the sole source of truth communication thread that can begin promptly at onboarding.
  2. Keep Referral Sources Up to Date: PDGs can be used to get critical information back to referral sources. This includes documentation, care details for payors, benefits, financial responsibilities, etc. Instead of having to make multiple phone calls, it can all be discussed in one secure message thread.
  3. Provide Collaborative Communications: Conversations can be tagged, recorded on the patient record, and integrated into the organization’s EMR—lessening the need for dual entry and helping to reduce errors. This all-in-one approach to referral management optimizes care teams with seamless communication and digital tools that make care collaboration easier than ever. The information shared supports fast billing, an informed referral source, and most importantly, an informed patient prepared to start service.
5 Actionable Solutions to Improve Clinical Communications with Your Referral Partners

The need for more real-time engagement is clear. Here are five ways more efficient communication can improve referral relationships:

  1. Referral sources want to stay involved in the patient care journey.
    Referral sources see many of the same pain points as home-based care providers when it comes to communication, interoperability, and transitions of care. With manual processes like faxing still in place for most providers, they want more digital pathways to be able to collaborate, automate workflows, and stay involved in the patient care journey.
  2. Patient noncompliance can be avoided.
    In a value-based reimbursement world, referral sources don’t want patients falling through the cracks, diverting from their care plans, or having other unexpected bumps in the road. Keeping the patient engaged in an omnichannel digital journey is a key mechanism to avoiding confusion, misunderstandings, noncompliance, and nonadherence to the care plan.
  3. Readmissions are less likely.
    The care plan needs to be put into play in a timely manner to avoid hospital readmissions. With more efficient communication, disease management effectiveness can be vastly improved through the ability to collaborate in real time, to have faster insight for concerns brought by patients, and for clinicians to make better, more accurate judgements.
  4. Care teams can collaborate with real-time messaging.
    With home-based care patients having higher acuity and more chronic conditions, the care team is widening. The ability to communicate across multiple care settings and various aspects of healthcare is beneficial for patients and their families—but also for the care team to understand what’s happening across the spectrum. This collaborative approach gives referral sources visibility into the care journey, with access to care teams through real-time messaging.
  5. What’s important to patients is important to referral sources.
    As patients become more consumer-like, the patient experience is going to be a key driver of their purchasing decisions. Knowing there will be smooth baton passes from acute to post-acute and other care providers is going to be increasingly important to patients—which means it’s going to be increasingly important to referral sources. Proper care now means keeping the patient and their disease states managed at home to avoid acute events.

At the end of the day, patients and families care where referral sources route them. Giving them a positive, seamless experience is going to reflect better on referral providers as well as CAHPS scores. Seamless communication and more efficient engagement are wins for all stakeholders.

Advancing the Care Team’s Productivity Checklist

Does Your Organization Have These Three Care Team Communication Capabilities?

A Checklist for Your Organization


Securely connect all clinical team members inside and outside your organization.

  • Ensure the care team is fully aware of and following the care plan.
  • Solve issues in real-time with clinicians, following physicians, pharmacies and HME suppliers.
  • Keep referral partners in the loop so they always know patient status.


Move to electronic workflows that increase staff efficiency.

  • Expedite physician order signature via digital document workflows, including app-less, secure electronic signature.
  • Conduct digital patient assessments and surveys.
  • Integrate documents and progress notes into EMR.


Put the patient and family caregiver first.

  • Ensure no urgent inbound communication is missed with auto-escalation tools.
  • Conduct telehealth and virtual visits through secure live video sessions.
  • Instantly engage the following physician or supervisors in a secure video chat with patient and family caregiver.
  • Offer on-demand education resources.