Referral Leakage is Invisible
Without real-time alignment, health plans lose millions to out-of-network leakage while PCPs remain unaware their referrals left the network.
Out-of-Network Leakage
25% of specialist referrals go to out-of-network providers—over one-third could be avoided with better referral management
Revenue Erosion
Patient leakage can equate to losing 10–20% of annual revenue in some health systems
Incomplete Referrals
Inadequate referral processes lead to missed care and higher costs—nearly half of all referrals are never completed
Suboptimal Routing
Up to 90% of completed referrals go to suboptimal specialists, inflating payer expenses and eroding network revenues
Referral Leakage Flow
How referrals silently leave your network
PCP Issues Referral
Primary care sends patient to specialist
Patient Self-Schedules
Books with out-of-network provider
Care Delivered OON
Visit happens outside network
Loss Detected
Only after claims processing (45+ days)
Too Late to Recover
By the time the health plan detects the leakage through claims data, the patient has already received care out-of-network. The revenue is lost, the PCP doesn't know what happened, and the pattern repeats.
How RefRE Works
Three-step system that closes the referral loop before revenue is lost
Detect
Real-time signal ingestion
RefRE monitors ADT feeds, FHIR endpoints, and claims signals to detect referral events the moment they occur.
Align
One-click PCP confirmation
Automatically route alerts to PCPs for instant confirmation before the appointment happens, not after claims.
Recover
Automated referral rerouting
When leakage is detected, RefRE coordinates with in-network specialists to rebook the patient and preserve revenue.
Real-Time Alignment Dashboard
Enterprise-grade monitoring that feels like mission control for referral integrity
Leakage vs Recovery Trend
6-month rolling view
Cumulative Revenue Preserved
Month-over-month growth
Live Referral Queue
Requires attention
RefRE doesn't replace workflows.
It aligns them.
Stop losing referrals to out-of-network leakage. Deploy real-time alignment infrastructure that preserves revenue and closes care gaps.
For health plans, ACOs, and value-based care organizations