50%
of specialist referrals are never scheduled, never completed, or lost between providers
Archives of Internal Medicine
75%
of clinical communication between providers still routes through fax
Office of the National Coordinator for Health IT
25%
of referring providers ever receive a consult note back from the specialist they referred to
JAMA Internal Medicine
$200B
estimated annual cost of poor care coordination across the U.S. healthcare system
National Academy of Medicine
A patient walks out of their primary care visit with a piece of paper and a hope that the specialist's office will call them back. Most days, in most clinics, in most cities, that hope does not survive contact with the system.
The handoff between a primary care provider and a specialist is the most common, most repeated, most consequential coordination event in American medicine. It happens five hundred million times a year. And the technology that carries it has not fundamentally changed since the late 1980s.
The fax machine is still the dominant medium for moving a referral. Voicemails are still how appointments get confirmed. Manila folders are still where consult notes go to die. The cost of this is not abstract. It is paid in delayed diagnoses, repeated tests, missed follow-ups, and patients who quietly fall out of the care path because no one was watching the line they were standing in.
What this looks like in practice
A patient is referred to a cardiologist on a Monday.
The referral is faxed. The fax never arrives — the cardiologist's machine ran out of toner three days ago. The primary care office assumes it went through. The patient assumes the cardiologist will call. Two weeks pass. Then four. The patient's chest pain worsens.
They end up in the emergency room with a stent procedure that costs eighty thousand dollars and could have been prevented with a two hundred dollar office visit.
This is not hypothetical. It is what happens to one in two patients referred to specialists in America today.
— The status quo of healthcare referrals
The conditions to fix this have finally aligned.
The referral problem has been broken for decades. What is different in the last eighteen months is that the technical, regulatory, and workforce conditions to actually replace the fax machine have all moved at once.
Value-based care
CMS continues shifting reimbursement from fee-for-service to outcomes. Practices that lose track of referred patients now lose money. Coordination has become a billable line item.
The NP and PA workforce
Nurse practitioners and physicians assistants now make up over a third of U.S. primary care visits. Existing referral tools were designed for physician-only practices. A generation of clinicians is being underserved by the technology built for the previous one.
AI-native automation
Insurance member-ID detection, network adequacy reasoning, and AI-drafted letters of medical necessity are technically achievable today in a way they were not even two years ago. The tools we are building were not buildable in 2022.