Author Archives: Vignesh Eswaramoorthy

Why Is HealthViewX The Next-generation Software In Patient Referral Management

What is Patient Referral Management?

When patients need advanced treatment or additional diagnosis that is not available within the practice, physicians refer them to a specialist/imaging center. The process of managing all the patient referrals that are received or sent is called patient referral management. It is a laborious process for FQHCs who refer patients to other specialists or imaging centers.

Challenges faced by FQHCs

One of our established clients based out of California is an FQHC who faced the following challenges in their patient referral network.

1. No single system for Referral Coordinators

The PCPs can create referrals on their EMRs. However, the referrals coordinators have to extract the referral lists that have been tasked on to their workgroup. They must manually pull down respective documents from patient chart to get the referral packet ready for Insurance pre-authorization. Then the referral coordinators must manually bundle the referrals and send those to the insurance company via fax. Post receipt of pre-auth acceptance, they have to manually track the rest of the activities. They have to communicate and coordinate with the specialist and patient, etc thus driving the referral to closure. In this workflow-intense process, the referral coordinators must hop through multiple systems like EMR, eFax, and spreadsheets etc. There is no system for the Referral coordinators to maintain and track the further status of the referral through the rest of its life cycle.

2. Cumbersome Insurance Pre-Authorization

Our FQHC client sends about 600 plus authorization requests per day to 15 plus different payers. Every authorization or referral packet has 14 plus pages. Some payers have their own physical forms that have to be manually filled in. These forms must be attached to the rest of the patient documents pulled from the EMR manually. Some payers have online portals for the above process. Considering the volume of authorization requests sent every day, it is not advisable to rely on a fully manual function. It makes the process cumbersome and prone to errors.

3. Specialist & Patient Referral Communication

From their EMR, referral order letters go to the patient. But the EMR has issues with its patient referral order template. Hence the referral coordinators have to manually design the template using MS Word and send it out. Specialist cover letters and reminder notifications in the EMR do not meet the requirements of the referral coordinators. They wish to customize and automate it.

4. Referral loop closure

Following up with the Specialists, receiving the reports back from the Specialist, and attaching it back against the patient chart in the EMR are completely manual time-consuming. Relying on only Fax & phone based communication for the same makes it cumbersome to manage as it has no effective means for tracking

5. Meeting Meaningful Use (MU) requirements with the EMR Share feature

Though the EMR SHARE’s main purpose was to help providers meet the MU requirements. In order to meet MU, the FQHC has to get the specialists to enroll on a direct message service so that they can use SHARE to transfer all orders. Though the FQHC already has the technology to meet the MU requirements, the issue is on the specialists’ side. Hence the EMR SHARE is not helping them meet the MU requirements.

HealthViewX is the Next-Generation Patient Referral Management Solution

1. End-to-End referral lifecycle management with bidirectional EMR/EHR Integration HealthViewX platform supports dynamic forms, workflows, task lists, reports, data visualization and has great integration capabilities. It has enabled our FQHC client to automatically pull referral orders from their EMR in real-time. It has also helped them in configuring all other referral coordinator workflows and tasks with maximum automation. Thus our platform has helped them achieve an efficient end-to-end referral management system.

2. Payer-specific prior authorization process automation

 HealthViewX platform has a payer management module that maintains and manages

  • different payer details
  • their modes of prior authorization
  • direct authorization procedures
  • payer forms
  • online portal links

With this information already present, it provides the referral coordinator the capability to automate

  • prior authorization submission
  • status checks coupled
  • fax integration

3. Automated Specialist / Patient Notification & Reminders with Customizable templates and configurable channels of communication

HealthViewX – Template engine platform along with the communication engine gives the flexibility to the referral coordinators to

  • choose the relevant format and mode of delivery for Specialist / Patient communication
  • tie it along with the referral workflows by setting trigger rules and reminder rules.

4. Secure Online referral portal for Specialists with easy touch points via Fax /SMS/Email

HealthViewX clearly understands the specialists’ referral preferences by,

  • Multi-channel referral consolidation that brings all the referrals from every possible source into a single queue.
  • Detailed referral information through which that the Specialist receives all the necessary referral details.
  • Ability to communicate back and forth (electronically or via fax) in a simple and secure way.

These are few notable features of HealthViewX that have enabled referral loop closure from the specialist side.

5. Free secure Specialist online accounts with both sides integration capabilities to meet Meaning Use requirements

As mentioned earlier, the problem with MU requirements was not, it was not met by the specialists. HealthViewX solution provides free online accounts for such specialists. It was highly useful to our FQHC client as we supported seamless integration between both ends. It helped the specialists meet the MU requirements.

HealthViewX Patient Referral Management application is the next-generation software for patient referral management. It has provided the best solution to the challenges faced by FQHCs. To know more about HealthViewX solution, schedule a demo with us. Our patient referral management experts will guide you through our HIPAA compliant solution.

Five ways In Which HealthViewX Referral Management Can Fix The Referral Problems Of Enterprise Hospitals?

Existing Patient Referral Management Workflow in Large Enterprise Hospitals

In order to understand how a patient referral works in a large enterprise hospital, let us consider a scenario,

XYZ hospital is a large enterprise hospital with 10,000 plus PCPs and specialists. It is a busy hospital that sends and receives 1000 plus referrals in a day.

  1. Mark visits the hospital – Mark hurt his leg and was bleeding. Even after three days, the wound did not heal. He visited his PCP, Dr. James. After examining Mark, Dr.James wants him to consult a diabetologist.
  2. Dr.James does the insurance pre-authorization – The PCP does the insurance authorization manually. He places a request with the insurance company and waits for their response. The process takes time and forces Mark to wait. After about four hours, Dr.James gets the consent of the insurance company for the diagnosis.
  3. Dr.James has difficulty finding the right specialist – St.Luke’s hospital had recently acquired a specialty clinic. Dr.James is not aware of the specialists recently added to the network. So he misses the famous diabetologist within the network and looks for someone outside the network. After considering many factors like the patient’s comfort, specialist’s availability, distance from the patient’s residence, specialist’s experience etc, he finally chooses a receiving provider.
  4. Dr.James sends the referral – Dr.James finally sends the referral to Dr.Hales after trying to reach the specialist office via phone. The line seems to be engaged. He looks for many other ways which will be easy to send referrals but to his disappointment, Dr.Hales accepts only referrals through phone or website.
  5. Dr.Hales schedules appointments – After receiving the referral, Dr.Hales schedules an appointment with the patient. Mark was not notified clearly about the appointment. So he fails to show up. It results in revenue loss for the specialist and patient dissatisfaction with the PCP. Mark who is still suffering from pain and waiting for the specialist to examine him. After two missed appointments, Mark finally visits the specialist.
  6. Referral progress updates and loop closure – Throughout the referral process, Dr.James is in the dark. Dr.Hales is busy and fails to give referral updates to Dr.James. He is anxious to know if Mark was taken care of. Without referral updates, Dr.James cannot close the referral loop.

Challenges faced by Enterprise Hospitals

  1. Insurance pre-authorization – The process of waiting for the insurance company to respond and approve the procedures or medication is time-consuming. If this process is automated it would save time and efforts of providers, insurance companies, and patients.
  2. Finding the right receiving provider – As many of the enterprise hospitals are joint ventures or acquisitions, the PCPs are not completely aware of the specialists within their network. Many times, the PCPs refer their patients to specialists out of their network. Finding the right provider outside the network is the greatest challenge as the PCP has to consider many factors. It is time-consuming and prone to errors when done manually.
  3. Patient Referral Leakage – When a PCP refers the patient out-of-network, it leads to referral leakage. PCP can avoid Patient referral leakage if the patient is referred within the network. When that is difficult, patient referral leakage is inevitable. If the patient is referred out-of-network and is not happy with the care given, the chances of the patient coming back to the PCP is less. Referral leakage causes revenue loss and patient dissatisfaction.
  4. Referral Analytics –  As a large number of referrals flow in and out of the network, it is difficult to track the exact number. It is also tedious to track the number of referrals in various status and to close referral loops.
  5. Referral updates and referral loop closure – When PCP refers patients out-of-network, the chances of getting referral updates are minimal. The specialist is usually busy and does not update the referring provider about the referral. Referral updates are crucial in closing referral loops.

HealthViewX Patient Referral Management Workflow in Large Enterprise Hospitals

Let us consider the same scenario used earlier and see the benefit of HealthViewX referral software to the existing workflow in Large Enterprise Hospitals,

  1. Mark visits the hospital – Mark hurt his leg and was bleeding. Even after three days, the wound did not heal. He visited his PCP, Dr. James. After examining Mark, Dr.James wants him to consult a diabetologist.
  2. Dr.James does the insurance pre-authorization – The PCP does the insurance authorization in the HealthViewX application. HealthViewX places a request with the insurance company and coordinates with them thereafter. The process takes place quickly and gets over in about 15 minutes Dr.James gets the consent of the insurance company for the diagnosis.
  3. Dr.James finds the right specialist in no time – St.Luke’s hospital had recently acquired a specialty clinic. Dr.James is not aware of the specialists recently added to the network. He need not worry as the HealthViewX application is updated with the current list of providers. With the help of the Intelligent Smart Search feature, Sr.James found the right specialist in his network.
  4. Dr.James sends the referral – Dr.James sends the referral to Dr.Hales via HealthViewX application. It supports many channels of referrals like email, website forms, type-enabled pdf, fax, online forms, etc. With the HealthViewX solution, sending out referrals takes not more than five minutes.
  5. Dr.Hales schedules appointments – After receiving the referral, Dr.Hales schedules an appointment with the patient. Mark is notified clearly about the appointment. He meets the specialist on time and gets treated. This improves his satisfaction and Mark plans to visit the hospital in case of any illness.
  6. Referral progress updates and loop closure – HealthViewX application supports a Timeline View that is available to both the referring and receiving providers. It says all about the referral and its history. Dr.Hales is not required to update Dr.James as it is taken care of by the application. Without referral updates, Dr.James can close the referral loop without any delay. Dr.James can receive feedback about the referral from the patient and the specialist. Depending on their remarks, he can improve the process in future.

HealthViewX Patient Referral Management solution is the best choice for Large Enterprise Hospitals. Are you a Large Enterprise hospital looking for a referral management solution to solve your referral challenges? Schedule a demo with us. Our solution experts will be happy to guide you through our HealthViewX HIPAA compliant Patient Referral Management solution.

HIPAA Compliance Checklist

The HIPAA compliance checklist is divided into segments for each of the applicable rules. One important point is that there is no hierarchy in HIPAA regulations, and even though privacy and security measures are referred to as “addressable”. It does not imply that they are optional. Any organization must adhere to each of the criteria in the HIPAA compliance checklist to achieve full HIPAA compliance.

It is necessary for organizations having electronic Protected Health Information (ePHI) to read through this HIPAA compliance checklist. The primary motive of this HIPAA compliance checklist is to help organizations comply with HIPAA regulations. Failing to this breaches the security and privacy of confidential patient data and results in substantial fines and even criminal charges.

Ignorance of HIPAA regulations is not considered to be a justifiable defense by the Office for Civil Rights of the Department of Health and Human Services (OCR). The OCR will issue fines for non-compliance regardless of whether the violation was inadvertent or resulted from willful neglect.

What is HIPAA compliance?

The Health Insurance Portability and Accountability Act (HIPAA) sets the standard for sensitive patient data protection. Companies that deal with PHI must have physical, network, and process security measures in place and follow them to ensure HIPAA Compliance. Covered entities (anyone providing treatment, payment, and operations in healthcare) and business associates (anyone who has access to patient information and provides support in treatment, payment, or operations) must meet HIPAA Compliance. Other entities, such as subcontractors and any other related business associates must also be in compliance.

HIPAA Requirements

Every Covered Entity and Business Associate that has access to PHI must ensure that they should

  • Adhere to the technical, physical and administrative safeguards
  • Comply with the HIPAA Privacy Rule to protect the integrity of PHI
  • follow the procedure in the HIPAA Breach Notification Rule in the event of PHI breach

All risk assessments, HIPAA-related policies and reasons why addressable safeguards are not implemented must be chronicled in case of PHI breach. An investigation will take place to establish how the breach happened. Each of the other HIPAA requirements is explained in detail below.

HIPAA Security Rule

The HIPAA Security Rule sets the standards for safeguarding and protecting ePHI when it is at rest and in transit. The rules apply to anybody or any system that has access to confidential patient data. By “access” it means necessary to read, write, modify or communicate ePHI or personal identifiers which reveal the identity of an individual.

There are three parts to the HIPAA Security Rule

  • Technical safeguards
  • Physical safeguards
  • Administrative safeguards

Let us address these in order, in our HIPAA compliance checklist.

Technical Safeguards

The Technical Safeguards is about the technology used to protect the ePHI. The important requirement is that ePHI must be encrypted to NIST standards once it is beyond an organization’s internal firewalled servers. This is to ensure that any breach of confidential patient data renders it unreadable, indecipherable and unusable.

Physical Safeguards

The Physical Safeguards focus on physical access to ePHI irrespective of its location. ePHI can be stored in a remote data center, in the cloud, or on servers located within the premises of the HIPAA covered entity.

Administrative Safeguards

The Administrative Safeguards are the policies and procedures which bring the Privacy Rule and the Security Rule together. They are the pivotal elements of a HIPAA compliance checklist. These require a Security Officer and a Privacy Officer to put the measures in place to protect ePHI.

HIPAA Privacy Rule

The HIPAA Privacy Rule governs how ePHI can be used and disclosed. In effect since 2003, the rule applies to all healthcare organizations. It demands that the implementation of appropriate safeguards to protect PHI. It also limits the use and disclosure of PHI without patient authorization. The Rule also gives patients or their nominated representatives,  rights over their PHI; including the right to

  • obtain a copy of their health records or examine them
  • to request corrections if necessary

HIPAA Breach Notification Rule

The HIPAA Breach Notification Rule authorizes the covered entities to notify patients when there is an ePHI breach. It also requires them to promptly notify the Department of Health and Human Services of such the breach of along with issue a notice to the media if it affects more than 500 patients.

There is also a necessity to report smaller breaches those affecting fewer than 500 individuals via the OCR web portal. These smaller breach reports should ideally be made once the initial investigation has been conducted. The OCR only requires these reports annually.

HIPAA Omnibus Rule

The HIPAA Omnibus Rule was introduced to address the areas that had been omitted by previous updates to HIPAA. It amended definitions, clarified procedures and policies, and expanded the HIPAA compliance checklist to cover Business Associates and their subcontractors.

HIPAA Enforcement Rule

The HIPAA Enforcement Rule governs the investigations that follow a breach of ePHI. It enforces penalties for covered entities responsible for an avoidable breach of ePHI and conducts the procedures for hearings.

What Should a HIPAA Risk Assessment Consist Of?

OCR provides guidance on the objectives of a HIPAA risk assessment:

  • Identify the PHI that your organization creates, receives, stores and transmits – including PHI shared with consultants, vendors, and Business Associates.
  • Identify the human, natural and environmental threats to the integrity of PHI – human threats including those which are both intentional and unintentional.
  • Assess what measures are in place to protect against threats to the integrity of PHI, and the likelihood of a “reasonably anticipated” breach occurring.
  • Determine the potential impact of a PHI breach and assign each potential occurrence a risk level based on the average of the assigned likelihood and impact levels.
  • Document the findings and implement measures, procedures and policies were necessary to tick the boxes on the HIPAA compliance checklist and ensure HIPAA compliance.

HealthViewX, a HIPAA compliant platform for Chronic Care Management and Patient Referral Management

How nice would it be if a solution like HealthViewX can protect all patient-related data securely? The practice need not worry as HealthViewX is a HIPAA compliant solution. We are passionate about making things easy for the healthcare industry. We offer three important solutions.

In this period, when the healthcare industry is experiencing its most drastic change, HealthViewX focuses on helping healthcare providers adapt and evolve to meet the changing needs of the industry and provide the best quality care for its patients.

Know more about our Care Orchestration Solutions to Improve Care, Performance, and Compliance! Partner with us for sustained healthcare outcomes, data insights and informed decision making!

Referral Management Software For Referral Inbound-Heavy Practices

In a year, practices receive 15 billion fax referrals in the USA. Practices receive referrals through fax, online forms, direct messaging, email, virtual print, direct walk-ins, and other channels. An imaging center or specialty practice or a dental center is a high inbound referral setup. Thousands of referrals flow in every day. So they need an effective referral management solution to manage the increasing inbound referral rates.

Traditional referral process in a dental center

In a dental center, a referral coordinator has to receive, accept and process the referral requests. The referral coordinator has to manually key in and create a referral, include all the patient information into the EMR/EHR/RIS. The referral coordinator takes around half an hour to process a referral request. The rate of processing is very slow. The referral coordinator finds it difficult to process even 20 referral faxes in a day. It results in piling up requests that are not yet processed. The referral coordinator is at loss trying to contact the referring provider for missing information. Patient referral leakage also becomes imminent.

Consequences of a slow referral network

  • The dental center loses its revenue they do not process referrals on time.
  • Providers stop referring the center thereby harming its reputation.
  • Patients may have severe illness and may need immediate attention. The waiting time may affect their health.

Problems faced

  • Handling many referrals manually in a short period.
  • Varied sources of referral make it difficult to get a comprehensive data about the referrals flowing in.
  • Limited referral information makes it difficult for the referral coordinator to proceed with the diagnosis.
  • It takes a lot of time for the dental center to contact the referring provider for clarifications.

HealthViewX Patient Referral Management solution at your aid

Patient Referral Management is complicated not only by the different sources but also by trying to manage all the referrals manually. The current referral management is no way close to the increasing demands of the referral process. Its inability to communicate between the referring and the receiving ends makes it slow and non-feasible. Relying on EHR/EMR/RIS for managing referrals makes it a costly affair and does not fulfill the current requirements.

Electronic Referral Management has been creating buzz for some time. Many applications are looking to solve the referral process issues. Before choosing one, a practice must consider the following aspects.

  • Simplify data sources – Capable of handling numerous referrals from various sources and bringing it to a platform from where it can be processed.
  • Data security – Sensitive patient data must be secured and protected.
  • Data Analytics – Complete analytics of the referrals flowing in, processed, missed etc.
  • Timeline View – To know the history of the referral and to what status it is attached to.
  • Integration with scheduler – To schedule appointments for the patients.
  • HIPAA Compliant – Secure data exchange of patient sensitive documents.

Any dental center receives a number of referral requests in a day. The referrals usually have an attachment in pdf form which will be not editable. They will have a form that has to be filled out with the details given in the referral. HealthViewX Patient  Referral Management comes to play here. Using Optical Character Recognition(OCR) the information from the referral will be read and the form is prefilled with the required details. Now the referral coordinator can just validate the details and create a referral and assign it for further action. The referral information can also be channelized based on the request of the user for eg: Two referrals forms can be filled in if it concerns people in different locations. The solution can be integrated with EMR/EHR/RIS and can write the updated information back the system used by them.

Problems Addressed

  • Single Referral Workflow Queue Consolidation – It collects Fax, Phone, Email, Website form referrals and manages them in a single interface. This helps in managing the referrals better.
  • Timeline View – Both the center and the PCP can view the timeline data of the patient in which the referral history is present. The referring and receiving providers can attach documents and notes at any time for one another’s reference.
  • To and fro Communication – At any time of the referral process, the PCP and the center can communicate with the help of the inbuilt secure messaging and voice call applications.
  • Referral Data Consolidation – It has options for printing the consolidated data about the referrals and the referral history of any patient as a hard copy at any time in pdf/excel.
  • Secure Data Management – HealthViewX Patient Referral Management is HIPAA compliant. It manages all patient-related documents securely.
  • Referral Analytics – Helps in tracking the number of referrals and gives complete information about the referrals processed, missed, scheduled etc with the help of a Referral Data-centric Dashboard.

HealthViewX Patient Referral Management solution helps dental centers in managing their referral network and increasing their revenue. Are you a dental center looking to track your inbound referrals very effectively? To know about HealthViewX Patient Referral Management System in detail schedule a demo with our team.

Ten Ways In Which HealthViewX Solution Can Fix Your Referral Management

Referral Management Process in healthcare

Patient Referral Management in healthcare plays a vital role in treating patients. The physician or the PCP identifies the need for a referral and sends it to the most relevant imaging center or specialty practice. A typical patient referral process goes through the following steps,

  1. Referral Initiation – The referring physician usually a PCP identifies the need for a referral and initiates medical referrals. A need for a referral arises when the patient needs advanced treatment or diagnosis that cannot be provided by a PCP.
  2. Insurance Pre-authorization – If the patient has an insurance coverage, the referring physician has to validate the same. The physician must do this to find the imaging center/specialist care practice comes under the patient’s insurance coverage. Most of the PCPs do this manually. It is a time-consuming process wherein the PCP has to wait for the insurance company to respond.
  3. Finding the right provider – Depending on the treatment required, insurance coverage and patient’s convenience, the physician will narrow down the search and find the right receiving provider for the referral. Dr.Miller is a primary care physician. A patient visits his clinic complaining of chest pain. After the initial diagnosis, the physician refers him to a specialist for better treatment. The referring physician looks for the best cardiologist in the city. Considering the patient’s and specialist’s comfort, the referring physician initiates the referral. This the more complicated than the insurance pre-authorization step as it takes more time and effort of the PCP.
  4. Sending out the referral – After finding the right provider, the referring physician shares the patient information and the diagnosis details with the receiving provider. The referral is sent via phone, fax, email, etc depending on the source, the receiving provider is comfortable in getting the referrals from. Most referrals are sent via fax. The PCP has to fill out a form and fax it to the receiving provider. This process takes a lot of manual effort as faxes and forms are tedious to work with.
  5. Following up with the referral – After the receiving provider receives the referral, the specialist may communicate with the referring physician for missing information. Most of the time, the PCP may not be available to the specialist for queries. This slows down the referral process as the specialist cannot proceed with the referral. The specialist who is also a busy doctor may not have the time to update the referring physician regarding the referral. This affects the referring provider as he cannot close the referral loop or get a feedback from the patient or receiving provider.

The referral process is quite demanding for the physicians. Communicating and giving timely updates is not easy with the current workflow. Considering the complexity of referral networks, an effective Referral Management Software is the need of the hour.

How can HealthViewX help in solving such challenges?

To sum up, these challenges cause a bad experience for the patients and providers. These challenges can be addressed by the unique features of HealthViewX.

  1. Simple referral forms – The patient demographics and diagnosis required are already in the application. The referral coordinator can create the referral through a simple three-step form.
  2. Insurance pre-authorization process – HealthViewX automates the insurance pre-authorization process. This reduces the manual effort of the referral coordinators.
  3. Intelligent Provider Match – Our “Smart Search” feature makes it easy for the referring provider in finding the right provider. It has smart filters and search options that help in narrowing down the specialist based on the requirements.
  4. Patient coordination framework – After finding the receiving provider, the referral coordinator refers the patient. When the receiving provider receives the referral, the provider will get notified of the referral. Even the patient will be notified of the referral. The receiving provider can schedule appointments based on the patient’s comfort.
  5. Timeline View – With the help of a referral status, the referring provider can get to know what stage the referral is. A timeline view shows a history of stages through which the referral has progressed. The chances of a referring provider missing out on referral updates are very less.
  6. HIPAA compliance –  The solution is HIPAA compliant and offers secure data exchange. It supports almost all formats of files and keeps the patient documents safe.
  7. Referral and timeline view reports – The health provider can generate the timeline view and referral analytics data as a report in any form.
  8. Referral loop closure and feedback – The referring provider can close the referral when it gets completed. The receiving provider and the patient can give a feedback on the referral process to the referring provider. Thus the referring provider can make it easy for the other the next time.
  9. Referral Analytics – Helps in tracking the number of referrals and gives complete information about the referrals processed, missed, scheduled etc with the help of a Referral Data-centric Dashboard.
  10. New Referral Channels – HealthViewX supports two channels of referrals, Desktop Direct and Type-enabled pdf for sending referrals. This reduces the time and effort the physician spends in filling in forms and sending faxes. The best part is that it does not require the referring provider to use our system.

HealthViewX Patient Referral Management solution smooths the referral process and fixes most of the challenges in a referral management system. Do you want to know more about HealthViewX Patient Referral Management solution? Schedule a demo with us.

How Can Physicians Benefit From HealthViewX Chronic Care Management Solution

More than half of the U.S population is suffering from various chronic conditions. Such patients need continued care and support from their physicians. Considering the physicians’ busy schedule, they cannot extend special support to every other patient with chronic conditions. This directly affects chronic patients. Both physicians and patients face a lot of challenges in the process of giving care to chronic patients.

Care Management Workflow for Chronic Patients

Let us consider a scenario to explain the care management workflow for chronic patients.

  1. The chronic patient gets sick – Lily is a diabetic patient who also had blood pressure. She fell down and hurt her head so severely that she started bleeding. As she was diabetic, the wound did not heal. She wants to visit Dr. Matthews who is her PCP.
  2. PCP examines the patient – Dr. Matthews is a busy physician who runs a clinic. Lily waits for two hours to get his appointment. The doctor examines Lily along long hours of her waiting. He advises her to stay in the hospital for two days. The nurses there take good care of her by giving her medications on time, attending to her whenever in need, etc.
  3. The patient gets discharged – After two days, Lily feels that she is all right. She is discharged from the hospital. Dr.Matthews prescribes her medications to be followed strictly to get completely well.
  4. Patient falls ill again – Though Lily takes care of herself, the wound starts bleeding again. She tries reaching the doctor but to no avail. It was only after a day did she get his appointment again.
  5. The patient is readmitted – Dr. Matthews examines her again. He finds that she did not take the medications appropriately. He advises her to stay in the hospital for another day.

Challenges faced by physicians

Though Dr.Matthews took good care of Lily, it could not avoid her get readmission. If only he had been more available to Lily virtually, this would not have happened. So what factors stop Matthews from being available to Lily?

  1. Outdated technology – Dr.Matthews’ clinic has a manual appointment scheduling method. Hundreds of patients call the clinic every day and the possibility of one getting an appointment is only 10%. This prevents him from catering to patients who need immediate diagnosis and attention.
  2. Limited resources – The availability of staff is less in number. Even if Dr.Matthews recruited new people, it would increase his operating costs significantly. The use of a new technology to manage the patient traffic is also not a great idea as it is costly.
  3. No remote patient monitoring tool – Patient readmissions can be avoided only when Dr.Matthews gives continuous care to his patients. He does not have a remote patient monitoring tool or the staff availability to handle it. Because of this, he is finding it difficult to be available to his patients.

Chronic Care Management Program

CMS was spending a lot of money on patient’s insurance who were suffering from chronic conditions. In order to cut down the expenses on hospital admissions, the CMS introduced the Chronic Care Management (CCM) program. Through Chronic Care Management program, the physician can give more attention and care to the patient.

What is Chronic Care Management?

Medicare defines Chronic Care Management (CCM) as non-face-to-face services provided to its beneficiaries with multiple (two or more) significant chronic conditions. In addition to office visits and other face-to-face encounters (billed separately), these services include

  • Communication with the patient
  • Health professionals being available both electronically and by phone for care coordination, medication management, and being accessible to patients.

HealthViewX Chronic Care Management solution to simplify the process

Chronic Care Management program is indeed a good idea to track your patients regularly. But when done manually, it becomes another burden for the physician. This is when a Chronic Care Management software comes to play. It reduces the time and manual effort spent in giving the CCM services. Let us consider the same scenario to explain the Chronic Care Management workflow,

  1. The chronic patient gets sick – Lily is a diabetic patient who also had blood pressure. She fell down and hurt her head so severely that she started bleeding. As she was diabetic, the wound did not heal. She wants to visit Dr. Matthews who is her PCP.
  2. PCP examines the patient – Dr. Matthews is a busy physician who runs a clinic. As he is Lily’s PCP, she has HealthViewX application in which she can see the doctor’s availability. She fixes an appointment with the doctor in no time. Dr.Matthews examines her and advises her to stay in the hospital for two days. The nurses there take good care of her by giving her medications on time, attending to her whenever in need, etc.
  3. The patient gets discharged – After two days, Lily feels that she is all right. She is discharged from the hospital. Dr.Matthews prescribes her a care plan with medications and exercises to be followed strictly adhered to.
  4. The patient is continuously monitored – Lily takes care of herself by adhering to the care plan prescribed. She gets monthly calls from the CCM team. If at all she falls sick, the application will help her to reach out to the physician as soon as possible.

HealthViewX Chronic Care Management solution features

HealthViewX Chronic Care Management solution has the following features that make the process simpler for physicians and patients,

  • Inbuilt audio, video calling and messaging features – HealthViewX Chronic Care Management solution has inbuilt video and audio calling features. It helps in giving Chronic Care Management services to their patients. Secure messaging is also available through which the physicians and the patients can communicate.
  • Automated call log feature – After a call, care plan creation or any action related to CCM health services, the system automatically adds call logs. It reduces the physician’s manual effort is logging the call logs.
  • Preventive Care plans – HealthViewX solution supports care plans for the Chronic Care Management service for a patient. The physician can create a care plan depending on the patient’s health report. It helps in monitoring the patient’s vitals.
  • Chronic Care Management Analytics – Dashboards with intuitive charts and tables give complete analytics of the Chronic Care Management services. It provides a clear picture of the revenue perspective.
  • Consolidated Report – The physician can generate a consolidated report of the Chronic Care Management services given for a particular period. This makes it easy for the billing practitioner for getting the Medicare reimbursements.
  • HIPAA compliance – HealthViewX Chronic Care Management is HIPAA compliant. It facilitates secure data exchange. The solution manages all patient-related documents securely.

HealthViewX Chronic Care Management solution has features that suit the physicians best. To know more about our Chronic Care Management solution, schedule a demo with us.