Care Coordination & Referrals

Care coordination pressure points are converging around post-acute placement, prior authorization, and behavioral health diversion: referral partners are increasingly weighing home health versus SNFs based on capacity, acuity, payer rules, and discharge speed, while reported Medicare Advantage access delays and broader denial rates are pushing hospitals to absorb more navigation and revenue-cycle burden. For VBC leaders, the near-term operational imperative is tighter referral management and real-time authorization workflows, especially as payers such as Capital Blue Cross report measurable impact from coordinated behavioral health interventions, including a 9% reduction in behavioral health-related ED visits. See: site-of-care referral decisions and Capital Blue Cross behavioral health ED reduction.