Referral Management: An Exploration of the Timeliness of the Referral Management Protocol within an Accountable Care Organization (ACO) between Primary Care and Specialty Care

Date of Award


Document Type


Degree Name

Doctor of Healthcare Administration (DHA)

Committee Chair

David Meckstroth

Committee Member

Scott Mcdoniel

Committee Member

Jesse Florang


An Accountable Care Organization (ACO) was first created during the enactment of the Affordable Care Act (ACA) in 2010. An ACO is a group of physicians, hospitals, and other providers that voluntarily form together to coordinate a value-based care approach that handled the best quality of care for patients and delivers the right care at the right time. The appropriate means of communication between these various groups are through referral management and processing. This study used an exploratory qualitative approach to understand the perceived barriers around components impacting the timeliness of referrals between Primary Care providers and Specialists. In-depth interviews with 21 participants that represented departments of primary care, specialty care, and operations were conducted via Zoom or Microsoft Teams in gathering their understanding on the efficiencies, barriers, and root cause analysis as it pertains to the referral process. The interviews were transcribed verbatim, coded, and analyzed for major themes. ATLAS.ti Cloud software was used for coding analysis of the collected data. The three major components that were discussed during the interviews were regarding network management, operational excellence, and technology enablement. Six major themes and 16 sub- themes resulted from the interviews. Recommendations for the perceived barriers were included for future healthcare administrators operating ACOs.