Referral networks are becoming larger and more complicated day-by-day. This makes closing a medical referral loop nearly impossible and ultimately results in care fragmentation. Tracking and managing a referral life cycle is a tedious task. Providers are at loss in trying to close the referral loop manually.

In a referral loop, a referring provider is the one who initiates the referral. The referring provider faces many difficulties in following up with the imaging centers or specialists and close the patient referral loop. Community Clinics or County Hospitals are clinics that have general physicians or PCPs who mostly refer patients out for specialized care.

For eg: Dr. Felix’s patient is suffering from chest pain. After diagnosing the patient, the doctor wants to refer him to a cardiologist who will have more expertise in this regard. After the referral is done the doctor was not receiving any updates regarding the progress of the referral. Did the receiving provider follow up with the patient? What will happen to the patient referral loop?

When does a referral life cycle remain unclosed?

There are many factors due to which a medical referral loop cannot be closed. Let us see it from the perspective of a referring provider

1. Time Spent – On an average, the referring provider spends about half an hour to one hour for creating referrals and even more time in following up the same.
2. No Updates –  The referring provider is not updated on the progress of the referral by the receiving provider or the patient.

Why care about closing a patient referral loop?

1. Patient’s Benefit – The patient may be in need of immediate care and attention. So processing and closing it at the earliest will be the best for the patient.
2. Patient’s Experience – If the patient is not followed up on time he/she may not feel good about it and there are high chances for him to move out of the network.
3. Referral Data Analytics – PCPs require concrete data of how many referrals were converted to an appointment by a specialty care or an imaging center. It will help in analyzing who responds quickly and to whom the PCP can direct future referrals.
4. Costs of poorly managed referral system – Millions of referrals are clinically inappropriate every year. Almost half of the physicians do not know if their patients saw the specialists. For each missed referral opportunity is a loss of revenue.

Managing referral life cycle with HealthViewX solution

A typical Community Clinic does a lot of outbound referrals where the PCP’s refers his patient to a specialist practice when the patient need expert advice or advanced treatment for a specific problem. The PCP generates a referral request with EHR system to a central team that has referral coordinators. The patient’s insurance is pre-authorized, the patient is referred to the specialist or imaging center. This is how a referral is done. It involves a lot of manual work and keeping track of the referral is highly impossible because a referral coordinator deals with thousands of these in a day.

This is when an automated Healthcare Patient Referral Management System comes in handy. Electronic healthcare referral management system helps healthcare organizations in the seamless processing of the referral process.

HealthViewX solution has implemented a referral consolidator that brings all the referrals in a single queue. The referral coordinator can validate the documents, attach new ones, merge it to an existing referral, create a new referral for it etc. The feature also lets the referral coordinator validate the patient insurance eligibility. Based on the specialist availability the referral coordinator can create a referral. The system can integrate with EMR/EHR and can also coordinate between the referring and the receiving sides. A referral has a status attached to it looking at which the referring provider can understand in what stage the referral is. Any referral has a timeline view which is common to both the receiving and the referring providers. In the timeline view history of the referral can be seen for eg: patiently related notes, previous status of the referral, etc. Documents attachment and status change can also be done at any time of the referral process. With the help of HealthViewX Patient Referral Management solution, the referring and the receiving provider can always have an eye on the referral and also close it in time.

HealthViewX Patient Referral Management Solution features

1. Seamless communication – HealthViewX solution has an inbuilt audio calling and messaging application which is secure and enables faster communication
2. HIPAA compliant data security – The solution is HIPAA compliant and offers secure data exchange. It supports almost all formats of files and keeps the patient documents safe.
3. Referral history – The timeline view provides the history and current status of the referral. A status helps in knowing the referral progress.
4. Data Analytics – A comprehensive dashboard helps to track the number of referrals in a queue and shows the number of referrals in different statuses. This helps in knowing how fast the referrals are getting closed.
5. Report Consolidation – The data regarding the referrals and timeline view can be printed as a report anytime in pdf/excel form.
6. No change in the current process – HealthViewX Patient Referral Management solution can be integrated with EMR/EHR and can write data of referral into any system if required. It is almost zero deviation from the current workflow a practice is using.

With HealthViewX Patient Referral Management solution in hand managing a referral life cycle is very easy. A 30-minute demo with our team will help you know how effectively the referral life can be tracked and managed. To know more schedule a demo with us.