Healthcare organizations are chasing direct-to-employer contracts. The pitch is compelling: transparent pricing, no authorization headaches, high-value surgical cases. But for most orthopedic practices, the direct employer relationship remains aspirational.
Aggregators offer a more practical on-ramp.
Companies like Transcarent, Carrum Health, and Coral have already done the work of contracting with employers. They bring together employer populations under bundled payment arrangements and steer those patients to quality providers. For independent orthopedic groups, aggregators represent an accessible entry point into value-based care without the complexity of negotiating directly with every self-insured employer in your market.
The opportunity is real. The navigation platform market is valued at $10.1B and expected to reach $24.8B by 2034. These platforms steer millions of patients annually. Accolade alone manages over 14 million member encounters per year.
But winning these referrals and keeping them requires infrastructure most practices don't have.
Proliance Surgeons, a 25-care-center orthopedic organization in Washington State, figured this out the hard way. They built a system from scratch, scaled it across eight aggregator partners, and eventually 3x'd their volume from one partner alone.
In a recent webinar, Tina Girardi (Director of Value-Based Care & Clinical Network Development) and Natalia Hairston (VBC Referral Coordinator) walked through exactly how they did it.
Here's what they learned.
Before diving into workflows, it helps to understand what you're working with.
Aggregators contract with self-insured employers to provide musculoskeletal care at transparent, bundled prices. The employer pays a single fee that covers the consultation, surgery, facility, anesthesia, and follow-up care. No surprise bills. No authorization delays.
For the patient, it's a white-glove experience. A dedicated navigator at the aggregator coordinates everything. They handle scheduling, answer questions, and ensure the patient gets to the right specialist at the right time.
For the provider, these referrals come with strings attached.
Aggregators require fast response times, often within 24 to 48 hours. They need clear communication about case status. They track everything and report back to their employer clients on metrics like time-to-appointment, surgical conversion rates, and patient satisfaction.
Providers who can't meet these expectations get dropped from the network.
The good news: each aggregator sends relatively few referrals. The challenge is that each one has different submission methods, different portals, different contacts, and different service level requirements.
Managing one aggregator is straightforward. Managing eight across 25 care centers without centralized scheduling requires a system.
When Tina joined Proliance, the organization was already working with a few aggregators. But referrals were scattered across inboxes, care centers were unclear on expectations, and there was no visibility into what was happening with these high-value patients.
Her first step was getting in the weeds.
She set up calls with navigators at each aggregator to understand their processes. If they used a portal, she learned the portal. She mapped out what information came with each referral, what service levels were required, and who the key contacts were.
Then she started building.
The foundation was an Excel spreadsheet. Not glamorous, but it solved the immediate problem: centralizing all referrals in one place so nothing fell through the cracks.
The spreadsheet tracked essential fields: patient name, which aggregator sent the referral, the patient's condition, the navigator contact, communication dates, and a status column that served as a running log of every touchpoint.
That status column became critical. Every email sent, every follow-up, every update from the care center went into that log with timestamps. It created an audit trail and made it possible to pick up any case instantly without digging through email threads.
But centralizing referrals was only half the problem.
Proliance has 25 care centers, 15 ambulatory surgery centers, and no centralized scheduling. Each center operates somewhat independently. When Tina started sending aggregator referrals to care centers, the response was underwhelming.
Referrals would sit. Care centers didn't understand the urgency. Some didn't know what a bundle was or why these patients needed different handling than standard referrals.
The fix was education.
Tina went to service line meetings and explained the fundamentals: what value-based care is, what transparent pricing means, why employers are moving in this direction, and critically, what the service level commitments were.
She also standardized the communication. Each referral email to a care center followed a template that included the aggregator name, patient details, the response deadline, and exactly what action was needed. No ambiguity.
When care centers didn't respond, she followed up. Not aggressively, but consistently. She documented everything in the spreadsheet status column, which created accountability and surfaced patterns over time.
Some physicians wanted to review records before scheduling. Others would take any case immediately. Tina learned each center's preferences and built that into the workflow.
Four months in, Tina hired Natalia to help manage the growing volume. The spreadsheet had expanded. The notes column was getting longer and longer as they documented each referral's journey.
Natalia describes her initial training as overwhelming. There was so much nuance to each case, so many different aggregators with different requirements, so many care centers with different preferences.
But the system held.
The key principles that made it work:
The spreadsheet became the source of truth. But as volume grew and more aggregators came online, the manual work was becoming unsustainable.
Proliance eventually moved their VBC referral workflow onto the Hatch platform. The results speak for themselves: 77% reduction in time to triage, 2-day reduction in time to completed referrals, and the ability to finally report on conversion rates and partner performance with confidence.
But the technology only worked because the system was already sound.
Natalia describes the transition as Hatch automating what they had already built. The platform's AI referral import feature pulls information from aggregator emails directly into the system. Location-based routing helps identify the best care center for each patient based on proximity. Standardized instructions ensure every referral goes out with the right context.
The fundamentals didn't change. What changed was capacity. Natalia can now handle more volume with greater precision, and Proliance has visibility into which partners and care centers are performing.
If your organization is considering aggregator partnerships or trying to systematize the ones you already have, here's where to start:
Foundation
Workflow
Education
Reporting
Tina and Natalia have made their VBC referral tracking spreadsheet available as a template. It includes the core structure they used to manage eight aggregator partnerships, along with guidance on how to use it and the principles that made their system successful.
Download the VBC Referral Tracking Template →
Joe: Natalia, we're all here. Hello, everyone! Welcome. So, so excited for you guys to be here. If you're looking for the Scaling Value-Based Referrals: How ProLiance Manages Complex Referrals Across Multiple Partners webinar, you're in the right spot.
I'm really excited for the session today. I've had the pleasure of maybe three conversations with the ProLiance team about this webinar, so we've got a lot of good stuff.
I'm Joe Zboch, I lead marketing here at Hatch. I'll be kind of the MC moderator today, but if I'm doing my job well, I'm not saying a lot. The stars of the show are Tina and Natalia, for sure.
Level setting on the goal today: an inside look, essentially, on the strategy behind value-based referrals at ProLiance, why they make sense strategically from a growth perspective, how they got started, and how they've scaled to where it is today. So essentially, you're gonna get a sweet narrative arc that I think is gonna be really engaging.
Along the way, feel free to drop questions in the Q&A. We are saving some time at the end, but if we don't get to it, we'll do a pretty good job of making sure we send follow-up emails to the team, because they're here and they're ready to share.
A couple housekeeping items before we dive in: we are recording the session. So if you have to jump, or if you want to send this to somebody else on your team, no worries.
Tina and Natalia were gracious enough to actually share the spreadsheet template that got them started—with one partner, then the next, then the next, then the next. So that'll be really cool if you are considering really diving deep into this type of strategy.
Without further ado, Tina leads the department, Natalia leads the coordination. Today, Tina will dive into the strategy, Natalia the specific workflows. So let's kick it off. Tina, give us an overview of what value-based referrals are, and what they mean for ProLiance.
Tina: Okay. Well, hi, everyone. Our value-based care referrals specifically come from many different avenues. We have them coming from payers, employers, aggregator companies, and schools. These organizations have people—which are patients, essentially—that need a medical service, and they refer to us.
One thing that I guess I should point out, because it's jargon for us, is what an aggregator is. An aggregator is a term that we use for referral partners. So any vendor, like I mentioned, that has a group of patients that need to refer to us.
And these companies, for the value-based part, are specifically working with us—independent orthopedic groups—not with the insurance companies. They're contracting with us directly, and we get the patient in and out. Everyone's getting great quality, high care, and at the price point that everybody wants and needs.
Joe: Nice. A few interesting things there. I think traditionally, the insurance company has a big part of it, but this seems to be more of a direct relationship, even though the aggregator is kind of an intermediary in a sense. These types of companies work with the employer specifically, and then they form partnerships with the supply side, like ProLiance Surgeons.
So tell me a little bit about why this investment in this strategy, these types of partnerships, actually makes sense for ProLiance.
Tina: Well, to piggyback, these aggregators and employers—they need and want the patient and the employers want their person to get back to work faster, first and foremost, right? So the way we do that is expediting things. We call it the white glove experience, and all around, it is direct access to us. There's no authorizations, there's no waiting period, and everything is transparent from the top, from the beginning. So we believe that we have the all-around white glove experience by building these relationships with these companies.
Joe: Yeah. The referrals that come from these aggregator navigators are kind of different in nature. Can you highlight some of the specifics and where they differ from, say, a traditional referral?
Tina: Yeah, so traditional referrals coming in from doctors' offices—we're billing their insurance, and they either come by fax or by internet referral, something like that.
These aggregator companies are coming to us in many different ways, sometimes just directly calling us or going through an aggregator company. And we have service line agreements with these companies where we talk about all the services that ProLiance can provide.
We have those in an agreement, and we have upfront pricing for all of them. So when a patient needs a service, like a surgery for instance, we are billing the employer directly, and they're paying for that patient's services instead of going through the insurance company.
And by being able to do that, we don't have to get approval, like that authorization for care. They have a direct line to us—they are emailing us, we have expectations with each employer and aggregator that we're working with that we'll respond within a certain amount of time. And depending on what the patient needs and where they live—are they flying in, are they driving to us—we can get them in pretty quickly.
ProLiance has 25 care centers, so depending on where the patient's at and how quickly they need to get in, we're able to accommodate those needs. That's what makes them a little bit different—because of the access point.
Joe: Yeah, okay. So bulleting that out, it's possible that a patient at one of these employers could find their way to ProLiance, but specifically that aggregator, that value-based care organization, is packaging up some level of experience. You've listed off price point, you've listed off direct access, and you teased at how fast they can get in. What are the key components of what makes this referral experience different?
Tina: Sure. So when we get connected with whoever the employer or aggregator is, they will be given one contact—which is Natalia. You guys will get to meet and talk to her.
As she gets that referral, she immediately starts looking at where the patient lives. Do they have preferences? Where do they live? What do they need? Are they in pain? How quickly do they want to get in?
And luckily for us, with those service level expectations, and us being across most of the state of Washington, if a patient's wanting to get in immediately, we do offer same-day, next-day service for all patients, not just value-based care referrals.
But if the patient can drive 5 more miles or 10 more miles, the great part about having that direct access is Natalia is the one reaching out to our inner teams. She is the sole point for all of these referrals.
So if she calls one care center and they're like, "Oh, we're a week out with this doctor," she can immediately, within that same minute of learning, go back and talk to that patient, that aggregator, to say, "Hey, we can actually get you in here. It's 15 minutes farther away—would this work for you, or do you want to wait one week, two weeks?"
When we say quicker care, it's every part of the patient experience, from the time the referral comes in, getting the appointment, getting the surgery, getting the payment—everything. All the follow-up has scalability and one access point, which is really helpful for these referrals in general and for the patient experience.
Joe: A lot of great stuff there. Specifically for people learning what it takes to actually accept these types of partnerships and referrals, a key part of it, Natalia, is you. Having a consistent contact point that serves as not only the liaison with the aggregator navigator but within the broader practice itself seems to be a key part of ensuring that white glove experience from end to end.
We're going to jump into building the system, but first, Donna has a question: Who do you communicate with on the employer side or the aggregator side? Is it HR, risk manager?
Tina: Yeah, for the employer side—well, actually, I take that back. All of our employers currently are connected through an aggregator, so the aggregators either have a marketplace or a care navigator. One actually has 14 navigators, but their 14 navigators talk to one person on our team—Natalia.
Now, if we were working independently with just an employer, so the traditional direct-to-employer without the aggregator, we would allow autonomy. You would want to talk to anybody in their company that has access to the patient. So typically, it is an HR person, but it can be a scheduler or a patient navigator on their side. We also can work with the patient directly as well, as long as we know it's through the employer.
We would set that partnership up based on that initial service line expectation meeting.
Joe: Excellent. Okay, let's get into building the system. I'd love to hear how and why you were brought on, where you got started, and if you could kick off a little bit of that with Doug's question here, which is about standardizing pricing and how y'all did it. Did you navigate business terms with each aggregator navigator, or is it across the board? Because the price point is one of the components of the nature of this partnership.
Tina: Yeah, great. So I was brought on to build relationships, right? Like, that's not on my job description, but that is what I am doing. Overseeing value-based care means that we get to help patients, employers, payers all get the best outcome—patient-centered.
So how do you do that? ProLiance specifically has 25 care centers and 15 surgical centers that we own.
Also fun fact for everybody: we don't have centralized scheduling, and we have 9 different medical record systems that we get to navigate. We did this to ourselves, y'all.
So what we did is—we are progressive. We like to think that we are progressive in this space. We want to be innovative.
I've been with ProLiance just over a year and a half, and one of the cool things we got to do is we talked about our bundle philosophy—what we want our bundles to be.
Transparently, whatever aggregator you work for, if you were able to see all of our pricing, it is going to be the same across the board. So if an aggregator upcharges, we are very firm on making sure that aggregator lets the employer know, "Hey, the base price is this, but we're marking up 2%, 3%," whatever they're marking up.
So what we did was first we started with what we wanted our bundle to include. For us, right now, our bundle includes 3 things: the consult, same-day surgical procedure, and anesthesia. We bundle those three things across—I think we have over 50 bundles right now, and we are multi-specialty, so that's across all of our specialties. A lot of orthopedics, but we do have some services that we will not bundle, but we do, in our contracts, make sure that we keep them open case by case. So we call those single-case agreements.
Joe: Okay, so Natalia's gonna get into the specific workflow later, but during prep, you'd mentioned that you had to fumble your way through this a little bit. It's brand new. But you did eventually 3X volume from one partner by creating this spreadsheet-based system. Tell me about the lessons learned, or the war stories, in terms of getting this off the ground.
Tina: Yeah, this is where it all happened. You gotta loosen your shoulders up, huh?
So when I started a year and a half ago, we were already partnered with 2 or 3 aggregators at the time. And I had to get in the weeds right out of the gate, because I did not understand what each one was, and why in the world we were partnering with all these different people. But we learned it's because they all have different employers, and they're all different ways of partnering with them.
So at first, everything just went into this vortex. Unless we were reaching out all the time, I always thought, "Oh, well, I sent that referral, so they must be working on it."
I found out very quickly that it is low volume, but high yield. But I had a problem navigating and remembering all the important pieces and the steps of the patient experience for the navigator side, our side, and again, with all the different EMRs and the care centers and the different people.
So this is where the Excel Bible started. It first started very high level—I could talk about this forever, and I'm happy to do so with anybody that wants to go down this avenue—but first, we had 3 different Excel spreadsheets because we had 3 partners.
But those Excel spreadsheets, we found out very quickly, needed to be merged into one because we were constantly flipping between MapQuest—no, we're not sponsored by them, but it was the quickest thing I could find to figure out where all the ProLiance sites were, where the patient lived, where was the quickest site to them—and then flipping open all of the spreadsheets on our contacts, their contacts, what the patient's surgery was, where they lived, when was the last time I talked to them, who was the last person I talked to.
So it was crazy, but that is how we first organized the development of this—what is now a platform.
Joe: I do want to pause and do a quick ad read. Today's webinar is sponsored by MapQuest. Just, from point A to B…
Tina: No, it's not.
Joe: No, it's not. I remember MapQuest, though.
Tina: Right? I'm like, oh, it's old school, but I needed a map.
Joe: At what point did you realize—there's no surprise to anyone, you guys are working with Hatch—the spreadsheet-based system can scale to a certain point and deliver 3X volume from one partner. What was the tipping point?
Tina: Yeah, the notes section got so big. The original spreadsheet has about 12 columns or something like that, but the notes section—you couldn't text wrap that—and it just kept getting bigger and bigger and bigger.
And then I found myself, before I was able to hire on Natalia, I was typing the same thing over and over and over again. And depending on who that person was on the other end, they needed more information. So I was like, wait, I need to standardize this, it needs to be the same across the board. And oh, yeah, they haven't seen one of these referrals in a long time because it's low volume, so then you have to re-educate them too on what this is and what they need to do with it.
So that's where, when Hatch was like, "Hey, we have this thing," and I was like, "Well, what's your thing?"
Joe: That's what our sales pitch was. "Hey, we have a thing."
Tina: No, they did say openly they had a solution for us, and in all fairness, they were not joking. We talked about the North Star, and we now have a path to the North Star, for sure.
Joe: Amazing. Can you share—so we did a pilot, it went well. Can you share a little bit about what that looked like in terms of some of the number outcomes?
Tina: Yeah, so like Joe said in the very beginning, I did 3X the volume, and truly, it was relationship building. I cannot overshadow that at all—it is the main glue that will keep you together.
And I'm actually gonna steal Troy's—our CEO's—phrase. The difference between a partnership and a vendor is, you know, when you have a partnership, you're communicating, you're talking, you're building, you're growing. A vendor is just somebody providing you this service.
So I took that very literally and made sure that we were good partners. Yes, they're giving us business, right? But we need to be good partners too, and I wanted to make sure that we could deliver on that.
So just building that—using that spreadsheet and increasing our communication—we did 3X our volume with one of them, and they even shared, "You guys have really turned this around and made the experience better. We want to use you more."
So that was obviously very exciting to hear from Hatch, that they could automate things to make us even better than we were. We know from our pilot: one, we almost eliminated all of our spreadsheets but one. We had a two-day reduction in our time to complete referrals. And then the biggest thing was the 77% reduction—that's so embarrassing to admit—in the time to triage, which was huge for the patient experience.
Joe: I love that. These are competitive referrals, right? You can win them. You can lose them. Direct-to-employer based, even workers' comp—a lot of referrals can fall under that umbrella. So when it comes to this, you compete on experience, and you guys were able to build out a system that delivers on that.
Joe: Let's dive into that specifically. Natalia, walk us through a day in the life. Where do these referrals come from? Talking about the spreadsheet system specifically—this is one of the giveaways—I want people to have a good picture of how they could actually use it. How did you work it?
Natalia: Yeah, so to start, I receive referrals via email or directly on an aggregator platform, and that's where the journey really begins. I start diving into the patient information, I download all the PDFs, I read into the records and imaging, identifying the condition and location of the patient. This will inform me which care center this referral should go to, if not already specified.
From there, I would input all of that information into my glorious spreadsheet. So I'm tracking all of the case owner, the condition, patient demographics, what they're being seen for. And then from there, I am now opening up Google Maps—I am not a MapQuest user—and then I go onto the ProLiance website as well, and have that side-by-side.
Then I find the closest care center to the patient. And once I find that, I go directly into our next spreadsheet—which is the care center contact spreadsheet—to identify who handles our bundled referrals and find that contact for that location that I had selected.
Moving on into the process, once I identify that point of contact, I start piecing together the email. That's where it really comes together. I go into my OneNote, I gather the instructions for the template that kind of just lets the coordinator know, "Hey, this is what you need to do," because again, low volume, so they need a little bit of education as a reminder.
I plug in what I need to plug into that instruction template—whether that's patient name, location, provider—and I paste that into the email. I attach my documents, review once more, and it should be good to go.
And then from there, I create a note on my calendar to follow up within that service level agreement to keep myself honest and make sure that the patient is going through this process as quickly as possible.
Then to complete the referral, I again go back to that large spreadsheet and document the aggregator contact that I have, the doctor potentially if that was provided, and then I'll go into that notes section. I will identify the step-by-step process of what I've done and what's to come next. So then I can go back and look at, "Okay, what do I need to follow up with?"
Joe: I think a key thing worth calling out is there's the relationship management between you and the aggregator that has a vested interest in making sure this patient gets timely care. And then there's almost the service level expectations that you have with the folks that are under the ProLiance brand as well—the schedulers at individual locations.
It seems like one of the most important things that the system you've built allows you to do is compile a really easy-to-follow, has-all-the-contacts-it-needs email, to carry that white glove experience through.
Can you speak to any other pro tips or call-outs you would have for other coordinators doing this sort of thing?
Natalia: Yeah, I would say find a system that works specifically for you. Not everyone works the same way or thinks the same way, and keep that routine. Organization, in this sense, would be the name of the game with these referrals.
Especially once more aggregators are being brought on, because when I first started, it was a lot to come into. But just finding that way, finding that process—I'm a very relatively organized person, but this keeps you on top of your toes.
Making sure that I'm documenting in my notes section, "Hey, this is what you have to do for today," every single day, to make sure that no patient gets lost in the process. We have about 8 to 10 different aggregators, so patients are coming from each direction, and I have to make sure that they all get to where they need to get to.
And then I think another would be: think two steps ahead. In the referral process, aggregators are looking for updates and surgery documents and next steps, so I tend to prep the care centers ahead of time to give myself and the care center time to deliver on time.
Joe: I love that. Ensuring that nothing is dropped by having the system in place. I think the national average for referral leakage, in terms of referrals sent but not completed, is like 34%. Tina, keep me honest—you guys have dropped one, and that wasn't… there was that weird situation, right?
Tina: Yeah, we only dropped one, and I know Natalia can speak to it. We hate to even admit that it was one, but I do feel like it was outside of—it was an appropriate drop.
Joe: Yeah, so it can be done.
Joe: Natalia, you walked through the before. Obviously through the Hatch pilot, a few things about that workflow have changed. Can you draw a comparison? And then definitely want to touch on the three main capabilities that you found are useful for this type of work.
Natalia: Yeah, so I no longer have to search for a care center closest to the patient via Google or our ProLiance website. I don't have to search for the point of contact at that specific location, or copy and paste referral instructions.
So now, with Hatch, of course I receive a referral, I download all the documents necessary, copy and paste any additional information, and I go ahead and open Hatch.
I do utilize the AI referral import feature. I copy and paste all my information within the email, the PDFs I attach, and then I now let AI create the referral completely.
What that means is that the process is completely automated, so I no longer have to fill into those fields individually. It just creates everything on its own. And while I'm waiting on that process, I now can tee up an email or I can go into my spreadsheet and update some things if I need to.
So now, once the AI is done composing the referral, I will review and just make sure all the information was imported correctly. I still select the location for the referral to go to based off the patient's address. The AI will grab that patient's address and then grab our care center's address to identify what is the closest location.
And then from there, it will also grab the coordinator on the other side for the care center—who I need to contact. So I no longer have to reach into our care center spreadsheet for that information either. It will all be teed up for me at the end of the referral.
So after that, all I have to do is copy and paste, open my email, prep everything, make sure it looks right, and send it off.
The AI referral import, the location-based routing, and the referral summary instructions—all teed up at the end—just saves an immense amount of time. I can now get through a referral—it used to take us about 10 minutes back when I was first starting. Now it takes me maybe 2 or 3 minutes. It's been amazing.
Joe: I like to do shout-outs. Is there anybody on the Hatch team specifically that you worked with, or that implemented something, that you want to give a shout-out to?
Tina: Yeah, I mean, Justin, Suzanne, Joe, and really even bringing it back to Chris. Coming here and being brave enough to change what our original partnership was—it was awesome.
And I can honestly say, to be transparent, it was double hand jamming for us at first. But I could see the benefit when I got to be in the room with them, hearing their mission and what they wanted to do, and they had the experience. They sat down with us and walked through my entire day with me. And then I found out there were even more things that I could make better, and they helped us make it better.
It was truly all of those people. Every single person that we worked with at Hatch had an input that was so helpful. It was like 24-hour turnaround, or it was like, "Hey, we're working on this this week."
It made me laugh, because I've never worked with anybody in the 20 years I've been in medicine that got something back to us, or built a product, and like, "Oh, we'll do this in a week, we can do this in a month"—and they came through on their delivery.
I wasn't being facetious when I said we talked about the North Star, and we have a pathway to the North Star for sure. I'm excited to be on the North Star as we get to use it the rest of the ways that it's capable of being used—the best of its ability on both sides, employer side and our side.
Joe: Thank you so much for that. I appreciate it. What's next on the roadmap?
Tina: Adding more partners, and then rolling out the partner portal piece of it. Because right now—and that's the other piece I want to make sure—we actually just kind of had an aha moment about this.
You do have the autonomy to gatekeep how you want to use this. You can have the Hatch portal to just one person, how we are right now. You guys heard me say we have 25 care centers. Only one person at ProLiance—well, myself if I need to—is in that portal, because we want to make sure we have everything going the way it needs to. But it essentially can be opened up to your entire organization, or any person scheduling, referring, navigating patient experience.
And going back—I should have explained when I said more partners. Right now, on our pilot, I believe we have 3 of our aggregators on there, and we even opened it up to a non-bundled partner, which was really cool. We opened it up to them because of the type of patient that they have—they have our first responders.
So they have an immense need to get expedited care, and so we've done more pilots within our pilot, because truly, we see the value in making sure that it's beneficial for both parties—us and the aggregators and partnerships that we're working with. We're excited to expand it and see what else is out there.
Joe: Yeah, I've heard through the grapevine that the ATC referrals and Chase and his team…
Tina: Yes, we also—thank you, I forgot that. We did add in our athletic trainers. So right now, our athletic trainers at ProLiance are using the Hatch platform for all of their patients at all the different high schools that they're at.
As you can imagine, we were working with 8 aggregators, and we had 8 different websites. I can't imagine how many high schools they had, or how many spreadsheets or pieces of paper they had. They're now just in their Hatch portal. Which is awesome for them—they've given us a lot of great feedback.
Joe: I see the emails and the posts coming in all day. I want to transfer over to the advice question. If you had advice, Natalia, Tina, for someone that is looking to invest in a VBC referral partnership strategy, what advice would you give?
Tina: I'm gonna tell you: just do it. Rip the band-aid off, figure it out. It is low volume, high yield. I cannot state that enough.
As long as you know up front the expectations from the partner that you're working with, you can figure it out. You just have to communicate. And I truly feel, with 25 care centers, if we can do it, you can do it! And we're happy to help with that.
It's where it's going, right? Patients want this, employers want this. People want to be able to go on a website, schedule their appointment, be on their way, and get it done. This is truly innovative and meeting patients where they're at, and employers where they're at—being truly readily accessible.
Joe: The low-volume, high-yield thing kind of reminds me of the airlines. Access and perishable inventory has kind of been one of the meta conversations in healthcare for a long time. When you look at business and first class, they make up a good amount of the overall margin for the flight. That's an interesting way to think about it.
And that's my segue, Doug, into your question. He is interested in the revenue side of things and what it means for the business.
Tina: Yeah, I can answer this two ways. One, hi Doug, nice to see you again—I think I know Doug. I'll answer this publicly this way. I actually pulled this up because I saw it in the chat.
Last year, of our 5 aggregators that we worked with—we now have 8—810 patients came into our door through those aggregators. And over 600 of them were surgical bundles.
So depending on what type of surgery they were, you can do the math on that. It was substantial. Somebody said—these were not my words—"We're not talking about coffee money, we're talking about boat money."
It was a substantial amount of money. When I say low volume, high yield, you're getting 3 to 5 patients a month. But because these are bundled services, it's a high, high dollar amount, because most of these aggregators are coming with patients teed up for surgery. Again, as long as your doctors believe, and the patient is wanting surgery, that that's in the best interest, they are teed up for surgery.
Joe: Now, we did a strategic growth roundtable late last year where Troy was on it as well, and I think he mentioned that you guys don't know necessarily which of these aggregators is going to be the winner. So you're making bets across all of them, and saying yes to all of them. And it fell on Natalia and Tina's shoulders to figure out the system to actually operationalize and scale those growth initiatives. Shout out again on that front.
I think the other thing in your talk that's sticking out to me is that you can have kind of decentralized operations in some ways. By centralizing some of the value-based experience piece of it, that allows you to have the agility to provide the experience and distribute those high-value referrals within your network or your system, and that's pretty cool.
Joe: Natalia, a question for you: How are you ensuring that these referrals are actually being responded to in time? Is the lion's share of that good instructions on the front end, or are you really good at just reminders?
Natalia: Yeah, so I do stay on top of my follow-ups, but I will say to start, once I got brought on, me and Tina did sit down with each care center and really went over the service level agreement. "Hey, these are the bundle referrals—this is our bundle program, these are our bundles, this is what we're doing, X, Y, and Z"—and really laid it out.
So everyone kind of had a level set, clear expectation on what's to be expected once I do email them with one of these referrals. And again, staying on top of those follow-ups. It's been working for us so far.
Joe: Tina, one question here, maybe to wrap us up. On the reporting and analytics side of things, a spreadsheet-based system can help the workflow—bit of a pun there—but it's not gonna really fill the growth and operational insight data gap. Can you speak to some of the metrics that you're paying attention to, that you have access to through this pilot?
Tina: Oh, yeah. This is actually my favorite part, because you get to see the ROI in all aspects of the patient experience.
In real time, we can see the volume from every aggregator that we work with, our partnership, in real time on the platform. We can see conversion to surgery, which I could not believe that Hatch was able to do that for us, but they did.
Because Doug laid it out perfectly for us—we wanted to know, of these referrals, is it really worth our time and effort to these low-volume patients? How many were actually converting to surgery?
It also helped us find our gaps. What I mean by that is, when you're in the system, anytime the referral moves from Natalia's plate to a care center, a care center to a doctor—and when I say doctor, the doctor reviewing the notes before the patient comes in, because one of the things that we didn't mention, we have flyers. What I mean by that is employers are paying for their employees to fly out of state to come and get services from us.
Which blew my mind—that it was cheaper to fly somebody out of state to Washington and not go through the insurance. That was mind-blowing to me, but very cool.
So that process—we're able to find out, was it because the doctor wasn't there that day? I'll use Troy's word: it gamifies. We were able to have a time clock on where the referrals were lagging and where our opportunities were.
And for us, having 25 care centers, we know which care centers can respond the quickest when we need it really quickly in real time. So that helped us tremendously.
And then, minus all the spreadsheets, it actually does the analytics behind the scene for us. We don't have to go to our internal business intelligence platform and click all the aggregators, run the platform and the date ranges. Hatch does that for us, and we see it in real time.
Joe: Amazing. Any parting words? Parting wisdom?
Tina: I would just say, reach out to us. If you have any questions, no question is a silly question. We are definitely happy to help in this space, and I just appreciate everybody jumping on.
This is really cool to be a part of, this part of patient care. It's new and it's different. But it's needed—it's definitely needed. We had almost 1,000 referrals last year, in 2025, from these aggregators.
Thank you so much for your time. I appreciate you guys doing this with us.
Natalia: Thank you!
Joe: Have a good one. Bye.
Tina: Take care.
