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Relevance and use of patient referral management software to FQHCs and large enterprise hospitals

Money inflow is very important for medical practices. Without a constant source of revenue, medical practices cannot pay bills, pay employees or take care of patients. Importance of revenue is no different for Federally Qualified Health Centers, Community Clinics, Large Enterprise, and Specialty Hospitals. One way to ensure constant revenue is by retaining patients within the hospital network and providing optimal patient care. To do this efficiently, hospitals use patient referral management software.

Role of FQHCs:

FQHCs play an important role in supporting their community and providing care services to the underserved. Due to this, they may experience financial issues at uncertain times. When budgetary resources are strained, it is critical for an FQHC to

  • Operate with maximum operational efficiency
  • Preserve financial security
  • Maintain staffing levels to continue operations

Inefficient and improper business processes will lead to patient dissatisfaction which will result in patients leaving the practice. FQHCs must concentrate on

  • Maximizing their business and staff efficiency
  • Minimizing financial risks

The relevance of patient referral management software to FQHCs

It is important for FQHCs to take good care of their patients. Factors such as waiting time, improper schedules, referring to the wrong provider, etc create patient dissatisfaction. Using referral management software, providers can access patient health records, schedule appointments and choose providers based on diagnosis and preferences. FQHCs can reduce patient-show rates, decrease referral leakage and also improve patient satisfaction.

FQHCs traditionally prefer working with EMR/EHR systems because they are comfortable with it. An EHR/EMR system has many advantages but when it is complemented with a Referral Management software practices can experience many more benefits.

The relevance of patient referral management software to Enterprise Hospitals

The following challenges in the patient referral workflow are common in enterprise hospitals across the USA.

  • Limited provider information – Physicians do not have information about the providers within their network. This is to blame for unnecessary out of network referrals. Providers who refer out of network could avoid at least one-third of these if they had access to more robust information about providers in their networks. Even when physicians have access to their health system’s provider directories, they are not using the directories because they don’t have the level of information that is needed.
  • Inadequate referral information – Even when physicians refer their patients out-of-network, the chances of a successful referral are less. This is because many providers who receive referrals rate referral information as poor. Without referral information, receiving providers cannot treat their patients effectively.
  • Inefficient patient appointment scheduling – For providers who schedule an appointment for the patient, they prefer doing it through the phone to shared electronic health records system. When heavy use of the phone occurs, it is difficult for providers to see capacity in their network to book the next available appointment. So they bypass the network and book the appointment before the patient leaves the office.

For FQHCs and Enterprise Hospitals, additional investment in a patient referral solution is recommended for the following reasons:

  1. Outbound and Inbound Referrals – HealthViewX Referral Management Solution can integrate with both the receiving and referring end. For inbound referrals, it helps in channelizing various sources into one single queue. In the case of outbound referrals, it facilitates integration with the existing system to read the patient data and send out referrals.
  2. Referral Timeline – In HealthViewX Referral Management System, any referral has a timeline, to capture and notify the progress of the referral to all the stakeholders. A referral will be mapped to a status which helps in tracking it better. With this, the providers can always be aware of how the referral is progressing.
  3. Workflow and Task Management – A workflow can be defined by how the referral flow must be(business rules). Tasks can be created to manage referrals by assigning it to the respective person.
  4. Improved communication – HealthViewX Referral Management Solution supports messaging and calling features for the referring and receiving providers to stay connected.
  5. Data Management – The solution is HIPAA compliant and enables secure data exchange of all patient-related documents.
  6. Seamless Integration – The solution can seamlessly integrate with any EMR/EHR/RIS or Third Party application thus providing minimal disruption in the existing referral flow.
  7. Referral History Consolidation – The consolidated data regarding the referrals and the referral history of any patient can be printed as a hard copy at any time in pdf/excel.
  8. Smart Search – HealthViewX Referral Management solution has a smart search facility that helps in finding the right provider for the treatment required.
  9. Referral Data Analytics – Referral data-centric dashboard gives complete data regarding the number of referrals flowing out, the number of referrals in various status, patient follow-ups, etc.

HealthViewX Patient Referral Management solution smooths the referral process and solves most of the inbound and outbound referral challenges for Large Enterprise Hospitals. Do you want to know more about HealthViewX HIPAA compliant Patient Referral Management solution? Schedule a demo with us.

FQHC Statistics – Growth, Region, Performance and Revenue – Federally Qualified Health Centers across the USA

What are Federally Qualified Health Centers (FQHCs)?

Federally Qualified Health Centers (FQHCs) in the United States are non-profit entities that are composed of clinical care providers, who operate at comprehensive federal standards. FQHCs were originally intended to provide the medically underserved population with quality care to minimize patient load in hospital emergency rooms.

According to Medicare and Medicaid statutes, FQHCs receive federal funding under Section 330 of the Public Health Service (PHS) Act to provide comprehensive primary care services to uninsured and underinsured populations thus ensuring that comprehensive care is available to all, regardless of income or insurance status. Medicare pays FQHCs based on the FQHC Prospective Payment System (PPS) for medically necessary primary health services and qualified preventive health services given by an FQHC practitioner.

To receive federal funding, FQHCs must meet the following requirements:

  • Be located in a federally designated medically underserved area (MUA) or serve medically underserved populations (MUP)
  • Provide comprehensive primary care
  • Adjust charges for health services on a sliding fee schedule according to patient income
  • Be governed by a community board of which a majority of members are patients at the FQHC

The Growth of FQHCs

In the early 1960s, there were only 8 health centers in the U.S. Ever since then, the numbers have increased exponentially. By 2001, there were 748 health centers at 4,128 service sites around the nation, serving approximately 10 million individuals.

Federal funding for health centers has increased from $750 million in 1996 to $2.2 billion in 2010. Federal support has increased tremendously over the last 10 years. In 2011, there were 1,128 health centers providing care to more than 8,000 rural and urban delivery sites in the U.S. and territories. Today, there are 1,400 organizations with 11,200 facilities serving about 25 million individuals every year.

The above chart shows the growth of health centers from its inception in 1980 till 2020. The chart also shows the exponential increase in the number of patients served over the years.

FQHCs in various regions across the U.S

State State Code Number of FQHCs
California CA 178
Texas TX 73
New York NY 70
Florida FL 48
Ohio OH 47
Illinois IL 45
Pennsylvania PA 44
North Carolina NC 40
Michigan MI 39
Massachusetts MA 39
Georgia GA 35
Louisiana LA 36
Oregon OR 33
West Virginia WV 31
Tennessee TN 30
Alaska AK 28
Missouri MO 28
Washington WA 27
Virginia VA 26
Indiana IN 25
Kentucky KY 23
New Jersey NJ 23
South Carolina SC 23
Arizona AZ 21
Mississippi MS 21
Colorado CO 21
Oklahoma OK 20
Maine ME 20
Kansas KA 18
Maryland MD 17
Montana MT 17
New Mexico NM 17
Wisconsin WI 18
Connecticut CT 17
Minnesota MN 16
Alabama AL 15
Hawaii HI 14
Iowa IA 14
Idaho ID 14
Puerto Rico PR 14
Utah UT 13
Arkansas AR 12
New Hampshire NH 11
Vermont VT 11
District of Columbia WDC 8
Rhode Island RI 8
Nebraska NE 7
Nevada NV 7
Wyoming WY 6
South Dakota SD 5
North Dakota ND 4
Delaware DE 3
Virgin Islands VI 3
Guam GU 2
Northern Mariana Islands MP 2

Performance of FQHCs

Figure 2 - Health Centers Perform Better on Ambulatory Care Quality Measures than Private Practice Physicians

Figure 2 – Health Centers Perform Better on Ambulatory Care Quality Measures than Private Practice Physicians

The above chart shows how health centers have outperformed private practice physicians in every aspect of service.

Figure 3 - Health Centers Provide More Preventive Services than Other Primary Care Providers

Figure 3 – Health Centers Provide More Preventive Services than Other Primary Care Providers

The above chart shows a comparison between health centers and other providers based on the number of patient visits for various ailments.

Figure 4 - Health Center Patients Are More Satisfied with the Overall Care Received Compared with Low Income Patients Nationally

Figure 4 – Health Center Patients Are More Satisfied with the Overall Care Received Compared with Low Income Patients Nationally

The above chart shows the level of satisfaction of low-income patients. Health center patients have a huge level of satisfaction as compared to other low-income patients nationally.

Financing and Reimbursements for FQHCs

FQHCs are required by law to provide services to all people, regardless of ability to pay. The uninsured are charged for services on a board-approved sliding-fee scale, which is based on a patient’s family income and size.

FQHCs are financed through various methods. These include a mix of Medicaid and Medicare reimbursements (with different payment methodologies), direct patient revenue, other third-party payers (private insurers), state funding, local funding, philanthropic organizations, and grant funding from the Bureau of Primary Health Care (BPHC) of HRSA of the U.S. Department of Health and Human Services (HHS).

The above chart shows the revenue distribution of FQHCs based on payer source (2018).

FQHC Revenue across all regions in the U.S (approx. 2018)

Source:
George Washington University analysis of the Health Resources and Services Administration’s Uniform Data System. Special Data Request, September 2019.

Location Medicaid Medicare Private Insurance Self-Pay Federal Section 330 Grants Other Grants and Contracts Other Total
United States $12,958,743,457 $2,260,247,981 $3,048,512,406 $1,248,741,884 $4,829,287,467 $3,336,624,219 $1,007,447,180 $28,689,604,594
Alabama $52,785,795 $17,803,287 $17,114,860 $12,744,350 $83,625,546 $13,471,556 $4,344,085 $201,889,479
Alaska $102,348,854 $18,671,815 $37,698,230 $6,477,465 $67,692,068 $119,544,705 $2,756,393 $355,189,530
Arizona $337,972,854 $47,634,000 $71,949,881 $23,395,361 $83,428,217 $41,485,739 $5,472,766 $611,338,818
Arkansas $62,148,511 $24,046,228 $30,622,521 $12,429,111 $54,555,352 $9,120,521 $1,735,385 $194,657,629
California $3,704,343,504 $411,514,109 $291,192,054 $148,976,225 $658,760,061 $615,047,232 $334,581,140 $6,164,414,325
Colorado $319,775,816 $39,134,784 $48,657,089 $30,779,398 $106,101,957 $95,942,011 $20,709,084 $661,100,139
Connecticut $228,434,332 $32,127,164 $26,544,878 $11,568,619 $59,696,129 $50,791,682 $10,598,421 $419,761,225
Delaware $11,773,644 $1,479,685 $2,463,464 $4,386,233 $13,557,989 $5,219,063 $470,309 $39,350,387
District of Columbia $160,105,430 $22,175,379 $32,105,709 $5,512,030 $27,476,019 $31,943,055 $7,236,844 $286,554,466
Florida $391,497,340 $60,674,510 $209,954,679 $81,714,253 $236,911,216 $193,834,424 $17,832,728 $1,192,419,150
Georgia $66,177,853 $48,142,417 $57,295,748 $30,758,262 $117,787,006 $28,848,026 $9,877,675 $358,886,987
Hawaii $107,408,992 $15,806,563 $17,253,126 $5,783,071 $31,398,131 $32,520,603 $3,907,118 $214,077,604
Idaho $45,572,373 $21,289,644 $50,122,229 $22,535,206 $45,993,298 $25,577,164 $3,267,335 $214,357,249
Illinois $455,197,448 $56,238,990 $131,100,822 $64,116,380 $201,027,383 $137,469,419 $29,398,121 $1,074,548,563
Indiana $200,004,374 $20,647,447 $30,284,051 $18,433,251 $75,547,860 $28,756,217 $30,759,622 $404,432,822
Iowa $83,853,103 $13,542,737 $23,553,367 $12,655,645 $38,528,294 $19,319,034 $1,624,245 $193,076,425
Kansas $37,808,462 $19,789,301 $26,840,099 $15,221,728 $44,761,541 $16,668,896 $4,665,564 $165,755,591
Kentucky $176,573,940 $46,631,367 $68,598,016 $24,819,874 $80,881,354 $6,773,516 $6,597,845 $410,875,912
Louisiana $146,815,697 $31,043,111 $59,995,751 $11,587,230 $100,474,957 $30,961,276 $4,441,509 $385,319,531
Maine $41,882,541 $35,423,228 $47,436,524 $12,099,407 $43,787,648 $11,360,335 $6,280,495 $198,270,178
Maryland $150,688,381 $29,260,626 $73,964,146 $13,146,680 $57,449,364 $35,657,860 $21,090,583 $381,257,640
Massachusetts $362,280,706 $103,012,238 $165,134,454 $27,248,100 $128,238,080 $258,007,270 $160,820,426 $1,204,741,274
Michigan $314,285,715 $68,214,766 $79,638,020 $28,291,497 $127,807,919 $44,375,118 $9,855,849 $672,468,884
Minnesota $75,452,268 $12,577,519 $16,837,190 $11,935,453 $42,977,632 $29,987,097 $4,128,981 $193,896,140
Mississippi $32,037,428 $18,436,338 $22,813,575 $21,440,111 $74,626,865 $14,886,816 $1,657,237 $185,898,370
Missouri $255,311,813 $26,546,831 $59,184,521 $28,003,100 $110,804,809 $33,834,797 $10,235,337 $523,921,208
Montana $34,073,242 $12,203,723 $17,685,163 $7,521,912 $42,126,575 $10,185,208 $6,307,871 $130,103,694
Nebraska $19,899,828 $1,982,820 $13,342,672 $7,991,555 $22,106,057 $22,906,355 $1,933,464 $90,162,751
Nevada $33,773,688 $11,166,606 $12,531,690 $3,172,460 $21,069,529 $15,948,721 $706,509 $98,369,203
New Hampshire $21,695,854 $17,132,960 $22,653,425 $5,099,829 $24,039,213 $11,899,812 $2,725,189 $105,246,282
New Jersey $158,938,887 $11,758,143 $14,145,131 $21,606,309 $81,666,571 $69,281,662 $5,982,249 $363,378,952
New Mexico $132,429,129 $26,364,684 $24,132,532 $15,923,683 $76,523,082 $57,190,428 $4,530,396 $337,093,934
New York $1,461,356,192 $201,623,297 $250,926,163 $50,171,017 $269,626,284 $385,124,022 $91,523,863 $2,710,350,838
North Carolina $90,190,949 $59,012,065 $65,516,943 $50,837,624 $133,899,942 $40,248,341 $26,574,283 $466,280,147
North Dakota $11,640,795 $3,863,326 $9,419,592 $4,474,860 $10,746,019 $908,251 $1,001,661 $42,054,504
Ohio $261,827,729 $51,042,970 $58,596,828 $25,007,037 $146,210,064 $41,839,517 $21,051,011 $605,575,156
Oklahoma $58,934,312 $20,089,581 $28,480,968 $19,992,107 $58,679,531 $10,582,038 $2,883,612 $199,642,149
Oregon $394,118,738 $51,503,384 $31,974,615 $15,310,703 $91,700,505 $91,028,195 $7,602,558 $683,238,698
Pennsylvania $315,531,242 $68,519,997 $104,374,387 $17,072,987 $128,243,325 $37,490,171 $10,326,309 $681,558,418
Rhode Island $109,670,334 $15,761,096 $19,797,174 $5,830,348 $28,040,434 $14,890,907 $4,960,361 $198,950,654
South Carolina $95,328,346 $89,583,350 $103,316,045 $25,145,381 $89,314,251 $31,444,029 $18,322,528 $452,453,930
South Dakota $11,514,028 $4,903,220 $10,207,221 $6,525,886 $17,900,812 $3,435,235 $1,231,547 $55,717,949
Tennessee $80,779,671 $26,920,974 $41,375,639 $15,091,806 $87,348,642 $31,856,403 $3,747,729 $287,120,864
Texas $405,350,935 $68,050,313 $170,985,325 $92,159,958 $258,162,160 $309,998,557 $26,687,781 $1,331,395,029
Utah $29,700,875 $11,520,256 $16,681,038 $13,794,751 $39,878,950 $24,880,704 $3,574,692 $140,031,266
Vermont $47,210,527 $31,973,872 $34,695,192 $23,137,643 $23,463,366 $7,348,657 $8,511,984 $176,341,241
Virginia $54,549,880 $39,744,588 $42,438,653 $26,005,991 $85,805,735 $20,677,091 $4,357,021 $273,578,959
Washington $769,937,162 $89,428,910 $129,151,433 $58,320,292 $139,027,744 $94,896,347 $14,596,022 $1,295,357,910
West Virginia $116,781,516 $57,847,408 $83,808,357 $28,402,025 $68,591,429 $16,910,711 $12,143,151 $384,484,597
Wisconsin $149,327,704 $8,202,250 $27,257,452 $10,451,845 $45,790,614 $27,262,928 $7,630,433 $275,923,226
Wyoming $6,918,264 $4,226,082 $5,490,411 $3,411,365 $7,478,734 $1,763,502 $477,559 $29,765,917
American Samoa $786,753 $0 $0 $0 $3,082,370 $0 $0 $3,869,123
Federated States of Micronesia $0 $0 $24,112 $84,319 $3,186,592 $0 $0 $3,295,023
Guam $2,451,828 $53,941 $17,002 $132,489 $2,173,874 $2,330,520 $137,227 $7,296,881
Marshall Islands $0 $0 $0 $31,865 $1,061,772 $1,086,917 $0 $2,180,554
Northern Mariana Islands $98,987 $641 $7,161 $11,185 $677,559 $0 $122,655 $918,188
Palau $0 $0 $259,006 $1,461,345 $940,810 $50,000 $0 $2,711,161
Puerto Rico $153,566,707 $33,237,486 $10,276,689 $7,922,019 $103,150,074 $16,880,374 $3,452,418 $328,485,767
U.S. Virgin Islands $7,822,181 $665,954 $589,383 $581,248 $3,678,153 $4,875,184 $0 $18,212,103

Definitions:
*Medicaid*: also includes the Children’s Health Insurance Program (CHIP), family planning programs, and state-funded coverage programs.

*Private Insurance*: includes employer-sponsored insurance and insurance purchased in the individual market (including the Marketplaces).

*Federal Section 330 Grants*: grants provided by the Health Services Resources Administration, Bureau of Primary Health Care under Section 330 of the Public Health Service Act.

*Other Grants and Contracts*: includes federal grants other than Section 330 grants, grants from state and local governments and private foundations, payments from state and local indigent care programs, and contracts.

*Other*: includes non-patient related revenue, such as fundraising, interest income, rent from tentants, etc.

Future of FQHCs

FQHCs have had significant growth in the past decades. The statistical data indicates that FQHCs have the potential to serve more patients by improving the quality of care. To provide quality care and improve patient experience, FQHCs must invest in the right technology like HealthViewX Care Orchestration Platform which provides the best solutions for the major challenges faced by the health centers.

Reference:

  1. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/fqhcfactsheet.pdf
  2. Kaiser Commission on Medicaid and the Uninsured (data from the National Association of Community Health Centers and the Uniform Data System (UDS) of the Health Resources and Services Administration (HRSA).
  3. Goldman, LE et al. Federally Qualified Health Centers and Private Practice Performance on Ambulatory Care Measures. American Journal of Preventive Medicine. 2012. 43(2):142-149. *Fontil et al. Management of Hypertension in Primary Care Safety-Net Clinics in the United States: A Comparison of Community Health Centers and Private Physicians’ Offices. Health Services Research. April 2017. 52:2.
  4. 2015 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS. National Center for Health Statistics. NCHS Data Brief. No. 220. November 2015. Hypertension Prevalence and Control Among Adults: United States, 2011 – 2014. National Committee for Quality Assurance. Comprehensive Diabetes Care, The State of Healthcare Quality (2016).
  5. Shi L, Tsai J, Higgins PC, Lebrun La. (2009). Racial/ethnic and socioeconomic disparities in access to care and quality of care for US health center patients compared with non-health center patients. J Ambul Care Manage 32(4): 342 – 50. Shi L, Leburn L, Tsai J and Zhu J. (2010). Characteristics of Ambulatory Care Patients and Services: A Comparison of Community Health Centers and Physicians’ Offices J Health Care for Poor and Underserved 21 (4): 1169-83. Hing E, Hooker RS, Ashman JJ. (2010). Primary Health Care in Community Health Centers and Comparison with Office-Based Practice. J Community Health. 2011 Jun; 36(3): 406 – 13.
  6. Shi L, Lebrun-Harris LA, Daly CA, et al. Reducing Disparities in Access to Primary Care and Patient Satisfaction with Care: The Role of Health Centers. Journal of Health Care for the Poor and Underserved. 2013; 24(1):56-66.
  7. George Washington University analysis of the Health Resources and Services Administration’s Uniform Data System. Special Data Request, March 2018.
  8. Community Health Center Revenues by Payer Source.

How Can Large Enterprise Hospitals Overcome The Challenges In Patient Referral Workflow?

Did you know? There are about 8000+ large enterprise hospitals in U.S. Recently, Becker’s Hospital Review released the list of top 50 large health systems. How is a hospital classified as a large enterprise hospital?

Hospitals which have typically 500 or more beds are categorized as Large Enterprise Hospitals. They are capable of serving the broader needs of the community. Some larger hospitals offer a combination of acute and long-term care services while also providing research opportunities in some cases and accommodating a variety of specializations.

Considering the huge number of patients in such hospitals, the referral numbers are also high. So such large health systems face challenges such as operational inefficiency, patient dissatisfaction, care discoordination and missed referral updates in their referral process. Let us go through the patient referral workflow in detail to understand their challenges better.

Patient Referral 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. In the workflow explained below, Mark is the patient who visits his PCP, Dr.James.

  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 prior 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 – The 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 of Patient Referral Workflow in Large Enterprise Hospitals

  1. Handling multiple EMR/EHRs – Large Enterprise Hospitals and Health Systems that are formed as part of mergers and/or acquisitions tend to handle multiple EMRs. EMR interoperability is their greatest challenge.
  2. Finding the right specialist – A Large Enterprise Hospital has huge number of specialists. PCPs are not aware of specialists who were newly added or who came within their network as a result of mergers or acquisitions. So many times PCPs tend to refer their patients out of their network in spite of having the right provider within the network.
  3. Patient no-show rates – When patients miss/forget or do not show up for appointments, it results in revenue loss for the hospital. Patients miss appointments due to various reasons like no reminders, waiting time, better specialist within the locality, reputation of the receiving provider, etc.
  4. Referral leakage – Did you know? Referral leakage for any health system can average anywhere from 55-65%! Patient leakage or referral leakage occurs more in an out-of-network referral than in an in-network referral. There could be many factors such as reputation of a provider, lack of knowledge or insight and patient’s choice that lead to patient leakage.
  5. Patient dissatisfaction – Large enterprise hospitals should keep in track of the number of patients moving out of their network. An alarming 25 to 50% of referring physicians do not know whether their patients see the specialist! Patients become dissatisfied with the treatment when specialists or PCPs do not follow-up with them regularly.
  6. 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.

HealthViewX Patient Referral Management Features for Large Enterprise Hospitals

  • Multi-channel referral consolidation – The HealthViewX solution can capture fax, phone, email, online form referrals or any other referrals in a single interface. It makes it easy to monitor and manage all channels of referrals in a single queue.
  • Intelligent Provider Match – The HealthViewX “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. This saves a lot of time for the referring provider.
  • Insurance pre-authorization process – HealthViewX automates the insurance pre-authorization process. The provider need not coordinate with the insurance company for prior authorization. The HealthViewX solution will do it for them. This reduces the manual effort of the referral coordinators.
  • 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. This will cut down patient no-show rates.
  • Timeline View to track referrals – 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.
  • Referral 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.
  • 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 smooths the referral process and solves most of the inbound and outbound referral challenges for Large Enterprise Hospitals. Do you want to know more about HealthViewX HIPAA compliant Patient Referral Management solution? Schedule a demo with us.

 

Reference

https://www.beckershospitalreview.com/lists/50-largest-hospitals-in-america.html

https://www.mass.gov/files/documents/2016/08/uy/2011-hcctd-full.pdf

https://www.beckershospitalreview.com/lists/52-great-health-systems-to-know-2018.html

Seven Ways In Which Artificial Intelligence Is Impacting The Healthcare Industry

Artificial Intelligence or AI has accelerated the growth in various industries. The growth has been pretty quick and sometimes, totally unpredictable. So, what is AI?

AI is a combination of various technologies that imitate human intelligence. It is an essential part of the technology industry. The core concepts of AI include programming computers for certain human traits like:

  • Knowledge
  • Reasoning
  • Problem solving
  • Perception
  • Learning
  • Planning
  • Ability to manipulate and move objects

Artificial Intelligence in healthcare

Artificial Intelligence has impacted modern healthcare industry to a great extent. With the application of AI, there has been tremendous changes in the way patients are treated by doctors.

AI can be applied to both ordinate and inordinate data, with techniques including machine learning and natural language processing. Nurses and doctors are adopting technology to

  • Reduce manual work
  • Provide more accurate service
  • Give impact interventions to patients

AI helps reduce the repetitive manual work and human intervention in data analysis. A good example of this is predictive diagnosis through which medical condition possibilities can be diagnosed by monitoring the vital stats and other necessary parameters. This helps providers prepare and provide necessary proactive care as foreseen by AI systems. The predictive possibilities of AI transcends to patient experience as well. Using chatbots and AI for responses to patients reduces the burden on manual intervention for scheduling appointments, responding to common queries on the website/chatbot/sms/apps, analyzing x-ray and basic scans and much more. This can help enhance patient experience with quick response times and avoid unnecessary hospital visits.

Medication management to ensure patients are taking medicine on time and prescribing medicine according to progress is also possible with artificial intelligence and this avoids repetitive human tasks.

The promise of AI in the matters of health, including that of life and death critical issues is highly impressive.

Impacts of Artificial Intelligence in healthcare industry

The following are the top seven impacts in the healthcare industry that are most likely to happen with the advent of artificial intelligence within the next decade.

  • Reducing the burden of EHR usage – EHRs are instrumental in the healthcare industry’s journey towards digitization. But the switch brought problems such as cognitive overload, endless documentation, and user burnout. EHR developers are now adopting AI for creating intuitive interfaces and automating some routine processes. Artificial intelligence may also help to process routine requests from the inbox, like medication refills and result notifications. It may also help to prioritize tasks that truly require the clinician’s attention making it easier for users to work through their to-do lists.
  • Operating mind and machine through brain-computer interfaces – AI can create direct interfaces between technology and the human mind without the need for keyboards, mice, and monitors. It is a cutting-edge area of research that has significant applications for some patients. Neurological diseases and nervous system trauma can affect abilities to speak, move, and interact meaningfully with people and their environments.  Brain-computer interfaces (BCIs) backed by AI could restore those fundamental experiences to those who feared them lost forever. Brain-computer interfaces could drastically improve quality of life for patients with ALS, strokes, or locked-in syndrome, as well as the 500,000 people worldwide who experience spinal cord injuries every year.
  • Inventing cutting-edge radiology tools – MRI machines, CT scanners, and x-rays produce radiology images that offer non-invasive visibility into the inner workings of the human body.  But many diagnostic processes still rely on physical tissue samples obtained through biopsies, which carry risks including the potential for infection. AI will enable the next generation of radiology tools that are accurate and detailed enough to replace the need for tissue samples in some cases, experts predict.
  • Improving care accessibility to underserved and developing regions – There is severe shortages of trained healthcare providers like including ultrasound technicians and radiologists. This significantly limits access to life-saving care in developing nations around the world. AI could lessen the impacts of severe deficit of qualified clinical staff by taking over some of the diagnostic duties allocated to humans.
  • Building intelligent medical devices and machines – Smart devices are taking over the consumer environment, ranging from offering real-time video from the inside of a refrigerator to cars that can detect when the driver is distracted. In the medical environment, smart devices are critical for monitoring patients in the ICU and elsewhere.  Using artificial intelligence to enhance the ability to identify deterioration, suggest that sepsis is taking hold, or sense the development of complications can significantly improve outcomes and may reduce costs related to hospital-acquired condition penalties.
  • Monitoring health through wearable and personal devices – Almost all patients now have access to devices with sensors that can collect valuable data about their health.  From smartphones with step trackers to wearable that can track a heartbeat around the clock, a growing proportion of health-related data is generated on the go. Collecting and analyzing such data and supplementing the same with patient-provided information (through apps and other home monitoring devices) can offer a unique perspective into individual and population health. Artificial intelligence will play a significant role in extracting actionable insights from this large trove of data.
  • Robotic assistance – Patients might not be comfortable with robots performing a surgery on them. How about combining the skills of a competent surgeon and the technical brilliance of a robot? That makes for a surgery with impressive levels of precision, steadiness and accuracy. And when we have AI guiding the hand of the surgeon through the help of robots, it opens the doors to extremely high levels of precision, and better patient outcomes. The AI assistant can provide patient’s past and present health details and give suggestions that would help in the diagnosis. Surgical bots use computer vision to perform surgeries after accurately calculating human body measurements. When a surgeon performs a complex surgery, AI can provide real time data that helps in identifying and reducing risk, and improving quality. Highly precise movements are made the robot hands so any tremors in the surgeon’s hands will be neutralized completely, enabling the progress and success of micro surgeries.

Benefits of Incorporating AI in Healthcare

Healthcare is definitely improving through AI. Patients and medical practitioners experience the following benefits,

  • Predictive medical care – Predictive healthcare will lead to an evolving treatment model wherein the patient data is reviewed constantly to check for any anomalies, followed by suggestions of medical intervention.
  • Personalized medication – AI makes it possible for patients to have personalized care based on their body constitution and past medical history.
  • Better diagnosis – Fast research and cross-referencing of data leads to better diagnosis of diseases
  • Advanced treatment plans – New treatment methods are generated and introduced, including robotic surgery, cell biology, stem therapy, genomics and proteomics.
  • Lower liability for hospital – Continuous monitoring of patients would ensure timely care and treatment and even reduced hospital stay.
  • Cost savings for patient and medical care provider – AI can make healthcare both efficient and affordable as it helps in
    • Guiding treatment choice
    • Making more efficient diagnosis
    • Helping patients make better decisions regarding their health
    • Taking important decisions in drug development.

The healthcare industry is evolving with Artificial Intelligence. It has a great impact on the role of doctors and patients. There are some challenges like managing and integrating large data sets that need addressing, but the benefits outweigh them, and AI is here to grow and expand. AI will change every medical word – in diagnosis, in treatment, in disease detection, in treatment disciplines and more.

Reference

https://www.cabotsolutions.com/revolutionizing-modern-healthcare-with-internet-of-things

https://healthitanalytics.com/features/ehr-users-want-their-time-back-and-artificial-intelligence-can-help

https://healthitanalytics.com/features/what-is-the-role-of-natural-language-processing-in-healthcare

https://healthitanalytics.com/news/ai-for-imaging-analytics-intrigues-healthcare-orgs-yet-starts-slow

https://mhealthintelligence.com/news/mhealth-for-children-4-concepts-that-could-change-the-world

https://mhealthintelligence.com/news/mhealth-wearables-ai-used-to-detect-diabetes-in-ones-heart-rate

All You Need To Know About Insurance Prior Authorizations In Healthcare

Insurance Pre-authorization in healthcare

Prior authorization is the talk of the healthcare industry since the increase in specializations in healthcare. Any healthcare process has its own pros and cons. Prior authorization is no exception to that. A Health Insurance Company must verify if the patient is eligible for an insurance for a certain drug or procedure. Before the physician prescribes it to the patient, it is a common practice to parallely check for authorization from an insurance company. 

Current Healthcare Insurance Prior Authorization (PA)  Workflow

  1. The physician recommends a lab test – A patient visits a physician complaining of leg pain. The physician suggests the patient get an X-ray to know what is causing the pain.
  2. The lab receives the order – The lab receives the request for the test and initiates the process of prior authorization.
  3. Lab conducts PA – A separate team is dedicated for PA in most of the labs. They check the PA requirements, health plans, etc. They retrieve patient-specific data like the history of medications, diagnosis done, etc
  4. Insurance agents review Prior Authorization – Lastly, the insurance agent reviews and validates the documents sent as a part of the PA process.

The ultimate aim of PA is to optimize patient outcomes by ensuring that they receive the appropriate medication thereby reducing

  • Wastage
  • Errors
  • Unnecessary prescriptions and drug use
  • Cost

Problems presented by the process of Insurance Prior Authorization

1. Time taking process for doctors – Physicians are dissatisfied with the time their staff has to spend interacting with health plans. When a procedure needs authorizing, it consumes a lot of admin time. It includes the time a physician spends persuading an insurance company to cover an expensive medication or a procedure. For most PA, physicians have to follow multiple steps. This involves

  • securing the correct form
  • filling it out with the required information
  • submitting the form to the plan

Physicians say that the overall process takes 30-45 minutes for each PA submission.

2. The cost involved in Prior Authorization – Though PA is the most talked about topic in the healthcare industry, little is known about its cost. In 2009, a study by Health Affairs estimated that on average, prior authorization requests consumed about 20 hours a week per medical practice

  • one hour of the doctor’s time
  • six hours of clerical time
  • 13 hours of nurses’ time

It further revealed that when the time is converted to dollars, practices spent an average of $68,274 per physician per year interacting with health plans. This equates to $23 billion and $31 billion annually! Prior authorization ultimately ends up costing the health care system more than it saves.

3. Patient delay – The real impact of PA is often felt by patients whose treatment is delayed. Nearly all physicians noted that wait times increased the delays in necessary care, which added to the risk of adverse events. According to AMA, a PA decision takes at least one business day for 64% of physicians and 3 or more business days for the rest. During this time, patients are unable to start treatment. These long wait times have a negative impact on patient experience and patient care.

4. Management of Prior Authorization – The management of PA can sometimes be difficult to manage. This is because the requirements can vary widely from one insurer to another. Each one has a different process for submitting prior authorization requests. The process cannot be standardized at times and must be done manually. This will of drain resources and time if this is already limited.

How can the Insurance Prior Authorization process be improved?

Healthcare Insurance Prior Authorization is a necessary step in many practices. But the current process is all too often manual and involves a cumbersome workflow. It may result in delays in treatment and dissatisfaction for patients and medical practitioners. As a result, many are implementing electronic prior authorization solutions to address common issues with the approvals process.

HealthViewX Referral Management solution makes the referral workflow easy for the practices. It has the following features that make the process of Prior Authorization simpler.

  1. EMR/EHR integration – Our System integrates directly with electronic health records (EHRs). This enables healthcare professionals to easily obtain prior authorizations in real time at the point of care. It also eliminates time-consuming paper forms, faxes, and phone calls.
  2. Timeline View – Both the center and the PCP can view the timeline data of the patient in which the referral history is present. Documents and notes can be attached anytime for one another’s reference.
  3. 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.
  4. 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.
  5. Secure Data Management – HealthViewX Patient Referral Management is HIPAA compliant. It manages all patient-related documents securely.
  6. 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 practices in managing their prior authorization process and saves their time and money. Are you a practice looking to ease your prior authorization process? To know about HealthViewX Patient Referral Management System in detail schedule a demo with our team.

HealthViewX Version 2 Is The Solution To The Challenges Faced By The Healthcare Industry

HealthViewX is excited to announce the launch of its all new version. HealthViewX 2.0 is advanced version of our healthcare product that has been,

  • Designed to suit any practice
  • Customized to meet the user requirements

What is HealthViewX?

HealthViewX is a care orchestration platform passionate about building a user-centric healthcare ecosystem. We aim at,

  • Improving patient and provider experience
  • Creating defined workflows
  • Raising the standard of care

We are at the forefront of enabling a collaborative platform for better care coordination & efficiency of care to enhance provider-patient relationship.

How does HealthViewX help?

The HealthViewX end-to-end Care Orchestration Platform guides healthcare organizations through its entire care journey by enabling data-driven decision support and providing real-time insights of patient reported data to promote better care delivery. The platform enables secure communication of patient information and remote monitoring of patient vitals to improve participation and create an interoperable ecosystem for care delivery. We provide three major solutions, they are,

What is exciting about HealthViewX 2.0 ?

In this period, healthcare industry is experiencing its most drastic changes in terms of technology. Every healthcare provider wants to give the best possible care to the patients in their network. So HealthViewX, a care-orchestration technology platform is focused on providing end-to-end healthcare lifecycle management. With enhanced technology, HealthViewX helps healthcare providers in,

  • adapting and evolving to meet the changing needs of the industry
  • providing the best quality care for its patients

Though HealthViewX has the right solutions for the pain points of the healthcare industry, customization was needed for each client. Through many discussions with our clients, we figured out that though many practices have similar challenges, each one had a unique workflow. Everytime we onboarded a new client, we had to modify the workflow to suit their needs. This was time-consuming and difficult. For eg: HealthViewX has a Chronic Care Management solution. One of our clients wanted to track all call logs within different ranges. Another one of our clients wanted to track only call logs with more than 60 minutes duration. This configuration was not easy as the components were static and not reusable.

This is when HealthViewX product experts wanted to make the product more reusable and dynamic. We realized that every practice had unique requirements and workflow. So we enhanced the product by making it a component-based with drag and drop workflow creation in minutes, simple user interface and real time plug & play usable components.

HealthViewX 2.0 features

HealthViewX solution has the following unique features,

  • Report and Analytical Engine – This helps the users in customizing the information they see on their dashboard and also the information they want to download as reports. Customizations mean the users can choose the format and what data or information they want to view. This information will be a great analytical tool for practices who can study such information and make changes accordingly in future to generate more revenue.
  • Module Engine – The users can now create and manage new modules (e.g. CCM, Billing module etc). Previously with version 1, module creation required more effort and time. Version 2 has made module engine so simple that it can be created by the users themselves.
  • UI Studio – The users can define the design and the layout of data on various modules and forms. This customization allows them to view the data in the way they want to.
  • Template & Form creation – This helps in creating and managing various forms in the platform (e.g. Prior-authorization form, Patient referral letter). For eg: In a prior authorization form, the user can design it with the information they need instead of using a standard form.
  • Integration Engine – This engine now enables setting up link between other systems (EHR, schedulers). The users can manage information on such systems easily with the help of this integration engine. Also it manages back and forth communication.
  • Communication component – It enables asynchronous Messaging, Fax, SMS, and Email. It enables the users to stay in touch always so that they don’t miss out on sensitive information.
  • Custom Workflows – The users can now create and update custom workflows that suit their practice.

HealthViewX solution is customizable and user-friendly. The above features are promising and solves most of the challenges in the healthcare industry. To know more about our solution, schedule a demo with us.