Tag Archives: referral management

How to Enhance Referral Process in Healthcare Organizations

Many large hospitals and health systems are losing revenue in millions due to patient referral leakage. Every single patient who looks for care somewhere else is lost revenue now and in the future.

Common challenges in referral system

Majority of health systems experience some sort of challenges with their referral process, which potentially create a negative impact on patient satisfaction, clinical care, and outcomes. More than two-thirds (68 percent) of specialists receive no information from primary care physicians (PCPs) prior to referral visits, according to the Journal of General Internal Medicine. And incredibly, 40 percent of PCPs do not receive consult reports back from specialists following referrals, according to the Archives of Internal Medicine.

A lot of other challenges like the below lead to patient dissatisfaction, poor patient health outcomes which in-turn results in patient leakage and revenue loss.

Not being able to identify in-network specialists/providers
Providing unclear and incomplete information while referring patients to specialists or other in-network providers
Lack of mechanism to measure referral team’s performance or revenue outcomes
Inefficient process and ineffective prioritization
Challenges in the insurance authorization process, issues related to denials and write-offs
Manual processes and dependencies on paper-based communication
Inability to track patient leakage due to unclear referral process and lack of referral analytics

Analyzing Your Health System’s Improvement Opportunity

It is vital to identify gaps in the current process, understand challenges and make significant improvements in the referral process. Standardizing the process will help to make it efficient, and adopting technological solutions will not only streamline the process but also will save time and seal leakage. Providers need an end-to-end referral solution to meaningfully improve the handling of both incoming and outgoing referrals.

Here’s how healthcare providers can improve their referral process

Standardize your referral process

It is key for organizations to develop a consistent workflow and streamline the referral process that clearly delineates responsibilities depending on the role and the action to be taken. To achieve this excellence both clinical and operational leadership should collaborate and identify a suitable solution to help develop a strong referral system.

Choosing the technological solution that works

In spite of having a proactive and organized approach to tracking and handling referrals, some technology systems are still unable to facilitate workflows of best practice or provide the performance data required to manage the end-to-end process effectively. So choosing the right solution, and defining roles and responsibilities to support better referral management is crucial.

Defining vision and goals

Once the right technology solution is adopted and implemented, it is vital for the health system to understand the level of performance and opportunity. Analyzing the understanding the below is required

From disparate referral process to a clear and standard process
From a decentralized to a centralized process
From paper-based or manual processes to an automated single system that manages end-to-end processes.

Measure success that matters

Organizations need to track their journey towards excellence and ensure they are in par with the industry standards to provide enhanced care for their patients through quality care and better patient satisfaction.

What organizations need to understand?

Organizations should invest time and effort into their referral management. The entire team including clinical teams, operations teams, IT, referral teams, etc. should involve in choosing the right referral solution for a streamlined end-to-end automated referral solution. They also need to understand the potential of the referral software, and the potential revenue a technology-enabled workflow can bring into the system.

Schedule a demo. Talk to our experts to understand how HealthViewX Referral Management streamlines the referral workflow and automates the process seamlessly.

Implementing Virtual Care in Referral Management to Enhance Patient Experience

Today, healthcare organizations are working diligently to improve care coordination, care continuity, and patient experience. Among these targets, improving patient experience is the primary goal that organizations want to achieve. Organizations are working towards streamlining processes to smoothen the patient care journey and improve the overall patient experience.

How can you deliver the best experience to patients?

Emerging global health challenges such as Aging baby boomers and increased chronic health issues have placed an increased strain on the existing medical and social services. The US healthcare system is the costliest in the world, accounting for 17% of the Gross Domestic Product (GDP) in 2018. This number is expected to grow to nearly 20% by 2020. [Source: National Healthcare Expenditure Projections, 2010-2020. Centers for Medicare and Medicaid Services, Office of the Actuary.]

Addressing all the three dimensions of triple aim at the same time is crucial. A systematic approach to streamline processes will result in a healthier population, and assure a seamless journey through the whole system of care. A comprehensive automation solution can help simplify processes, and enable the entire system to manage change in a structured manner, paving the way for better patient experience.

Today, one of the processes that would be improved with automation is patient referral management. Patient satisfaction or experience, and quality care depend on effective care coordination not just within the physician’s office but also between physician’s primary health centers, and other care settings (specialty centers, hospitals, health systems, etc.). Using a smart platform for prior authorization, specialists match to alert when referrals need attention and automatically send patient updates to referring providers. This provides them with real-time analytics to gain better insights and also closes the referral loop, which addresses the biggest issue in the referral process today.

Ensuring care continuity and coordination of care for patients by easily scheduling the right specialists will transform the health center to meet the patient’s comprehensive health needs. Increased efficiency of the referral process leads to quality care and better patient experience.

The Use of Video Conferencing in Referral Management

Innovative methods are needed to enhance care quality, improve access to care, and improve patient outcomes. Video conferencing is one such feature that enables real-time two-way video with audio transmission and sharing of diagnostic images, and more. It helps patients to access healthcare services without the burden of travel and receive timely care.

Want to know more? Schedule a demo and talk to HealthViewX solution experts to understand in detail about our virtual care capability in the Referral Management Solution.

It’s time to stop faxing referrals – Why are we still faxing patient referrals?

One out of every three patients is referred to a specialist each year. These referrals are sent to specialists, imaging centers, etc., through multiple channels like phone calls, fax, emails, website forms, etc., and fax is the most commonly used channel. Despite the array of digital patient referral management software available in the market, health systems are still following the old school model of referring patients through fax machines and paper-based letters. Ironically, there could be multiple barriers like the reasons listed below for not using the electronic referral communication software

Traditional workplace culture
Not having the right technology in place
Not understanding the software usage
Peers not using eReferrals

Healthcare professionals need to understand the usability, security, and interoperability of the solutions available in the health IT market. Health systems need to adapt to more secure means to send and receive referrals. With that being said, Referral Management Solution is progressively vital for better patient experience and care coordination. Today, in most health systems referral workflows are poorly documented, insecurely sent and are not effective in providing quality care for patients.

Knowing the security consequences of maintaining paper-based systems and physical paper letters is critical – as they could be easily misplaced and accessed by unauthorized people. Some health systems still depend on their EMR to manage their referral process but they need to understand that EMR’s are not equipped enough to handle the end-to-end referral process. Health systems should understand the need of having a good patient referral solution.

Why do health systems need a good patient referral solution?

The healthcare industry is constantly scrutinized for inefficiencies in processes, systems, operations, etc. As a result, health systems are under more pressure to do more with fewer amenities. Inefficient referral processes lead to long lead times and are inconvenient to both patients and providers. A referral solution can streamline communication between the referring provider, receiving provider, patient and other healthcare providers, save time, enhance care quality and a lot more for both patients and providers.

Revenue lost due to patient leakage in hospitals and health systems

The last few years have been a tumultuous time for hospitals and health systems due to the high patient leakage rate. Even today, patient leakage is a key concern and remains an unsolved challenge in many of the health systems. Health systems are losing more than 20% revenue due to inefficient organizational referral processes, as a result, patients are opting to different care providers for their care needs. Identifying the gaps or latitude to go out of the system, and sealing this, is the basic step that health systems need to take in solving patient leakage challenge.

What are the main causes of patient leakage?

Here are some reasons why patient leakage happens

– Referring physicians refer patients to out-of-network providers

– Patients move out of the care network due to poor care coordination

– Unavailability of a specialist within the care network

Patient Leakage and its consequences

Though in most hospitals patient leakage is contributing to significant revenue loss, this loss is ignored, and not given much importance. Health systems and hospitals need to consider this leakage extremely important. Non-coordinated or fragmented care is one of the main reasons for patient leakage. The point is to emphasize on some damaging consequences patient leakage can bring on care quality and patient health outcomes.

Understanding the actual causes of this leakage and taking tangible steps to address this challenge is vital. It is the responsibility of the health system to track and manage patient referrals in a better way with a solution for tracking leakages and referrals. Otherwise, it can damage the health system’s reputation, undermine its brand value, and even jeopardize its competitive edge.

Challenges in processes that cause patient leakage

Streamlining different processes for different aspects is required for better overall operational efficiency. One such process that needs attention to arrest leakage is the patient referral process. Health systems need to adapt to solutions that will help seal this leakage. HealthViewX helps referral coordinators in health systems to manage patient referral efficiently and improve care, performance, compliance, and reduce leakage.

The current referral process lacks certain mechanisms to make this process effective. Hospitals and health systems need a referral solution in addition to an EMR to solve their referral challenges especially referral leakage.

An ideal referral solution for hospitals should have the following features

Multi-channel referral consolidation

Health systems have multiple access points for patients and chances are that health systems may miss following-up with some referrals. The solution needs to consolidate referrals from multiple sources like fax, email, phone calls, online forms, etc. It should integrate well to bring all of these referrals into one single queue and ensure not a single referral is missed.

Secure exchange of information

A HIPAA compliant solution that supports the secure exchange of sensitive patient information among the care providers involved in patient care is a must. The provider should be able to attach documents securely at any time for one another’s reference.

Patient referral history

Both the referring physician and the receiving provider should have access to the entire referral history. All required information right from the time a referral is initiated and consequent diagnosis reports, referral status, etc. should be available at any point of care.

Scheduler Integration

Patient convenience is one of the most important factors in providing care. Scheduling appointments as per patient convenience and automated reminders for both patient and provider about the appointment is mandatory.

Dashboard and referral insights

The solution has to give complete data of the referrals flowing into the health system. The number of referrals processed, number missed and many more as per the requirement of the health system. These data analytics should give the practice a clear picture of how referrals are handled and where the leakage is happening.

Speak to HealthViewX solution experts to understand more about HealthViewX Referral Solution features that will help solve some of the challenges in the patient referral process and increase revenue through effective tracking. Schedule a demo today!

Transform Your Care Practice With A Streamlined Patient Referral Process

It is imperative to transform your care practice to deliver value-based care. Promoting and exploring technologies for streamlining various processes is the way forward for improved care quality and care coordination. One such process that requires a transformation in care practices is the patient referral process which is still a tedious, fragmented, and time-consuming task for referral coordinators in many health systems. The conventional patient referral process (both inbound and outbound) results in more stress for the referral coordinators and poor patient satisfaction. This inefficiency in the patient referral process leads to frustrated referral coordinators, physicians, specialists, patients and health systems as a whole. Patients not showing up for scheduled appointments are revenue loss for health systems that are trying to keep their patients within the network for better outcomes.

Today’s patient referral process makes it hard for patients to get the care they need, and healthcare facilities the visibility they need in the process. Additional challenges like lack of communication amongst providers, appointment delays, no-show rates, incorrect referral, etc. all have far-reaching consequences. Ineffective communication between clinical teams leads to poor health outcomes of patients and lost revenue for health systems. It is not a surprising fact, that more than half of the PCPs and Specialists are dissatisfied with the information they receive during a referral.

How to eliminate these challenges in the referral process?

A technological referral solution that offers end-to-end automation and is convenient for patients and providers is required to actively manage referrals and improve efficiency.

Healthcare providers need to adapt to an advanced technological solution that

– is patient experience focused, process-driven, and easy to use

– improves PCP, specialist experiences

– has end-to-end referral workflow automation

– intuitive dashboards with data insights and analytics

HealthViewX Patient Referral Management Solution is designed to help providers to focus on delivering high-quality coordinated care by keeping track of their patients throughout the care continuum. The solution makes the referral process efficient and simple with no burden on practice staff. It helps improve patient experience, reduces the burden on staff, improves operational efficiency, and overall benefits the health system in processing referrals.

Streamlining the patient referral process can help with

– better care for individuals and the community as a whole

– lowered cost and improved operational efficiency

– reduced paperwork for referrals

– awareness of in-network and out-of-network providers

– improved patient experience and value-based care drive

– better care coordination among providers

– visibility into real-time data to understand referral patterns, referral staff performance, patient status tracking, and gaps in care.

HealthViewX Patient Referral Management Solution helps solve challenges in all stages of the referral workflow to meet the needs of the patients, healthcare providers, and payers, and also integrates seamlessly with all EMR systems. An intelligent end-to-end automated solution is essential for better provider connectivity, reducing network leakages, improving quality care, and better health outcomes.

Schedule a demo today with our experts to understand how our solution seamlessly solves challenges in the patient referral process.

Advantages FQHCs Gain From A Patient Referral Management Solution

Community health centers or federally qualified health centers provide critical primary care services to tens of millions of people every year. Their role in healthcare makes them necessary access points for patients coming into the vaster healthcare system. Let us see how these organizations use patient referral management systems to leverage their role as a crucial source of patient referrals and enhance the care they can provide for their populations.

1. Making a more combined provider network:

Right from small to large, FQHCs are moving towards providing value-based care for their patients. Many FQHCs have discovered that requests for better care coordination with specialists go unheard until there is a change in the current referral process. FQHCs have realized that technology can provide them with the ability to differentiate from their competitors while helping them deliver quality care to their patients and closing referral loops. An efficient referral management solution will help them organize, quantify, and ultimately shape their referral stream and improve care coordination.

2. Improved patient support and access to care:

Insurance prior authorization is one of the major challenges in the patient referral process. Finding the right specialist, insurance prior authorization, ensuring the patient visits the specialist, getting the information back, and updating the information back to the EMR is all crucial inpatient care. A referral management solution helps FQHCs to automate end-to-end referral process and helps them close referral loops with ease. This improves patient experience and increases their access to quality care.

3. Improved referral workflows:

Many FQHCs lack care coordination in their current referral process. Manual processes are both time-consuming and tedious. Simplifying the referral workflow will not only help referral coordinators and patients but will also help the FQHC performance as a whole.

4. Better care coordination and patient outcomes:

In an efficient referral process, patients get the care they need. This involves referring the patient to the right provider, ensuring insurance pre-authorization, scheduling appointments, sending reminders, and updating the patient information back into the EHR. All these steps contribute to better care coordination and patient outcomes.

5. Increased referral loop closures and MU Credits:

Receiving a report from the provider to whom the patient was referred to and updating that information back into the EHR is critical for FQHCs. Referral loop closure is essential for better care coordination and will help FQHCs improve patient experience and outcomes. A referral solution that is MU stage 3 certified can help the practice with MU credits, as referral transferred using the platform can be counted for MU credits.

Talk to our solution experts to know more about Patient Referral Management Solution.