Why Patients Require Improved Referral Management From Their Doctors?

Why are patients not happy with the existing referral management?

In the existing referral management workflow, patients face many challenges,

  • Location of the receiving provider’s hospital – The patient will prefer visiting his PCP as the PCP will be in his locality. In order to visit a provider in a hospital which is not is the same locality requires a lot of effort from the patient’s side.
  • Patient unhappy with the receiving provider – Many times, the patient may not be happy with the care he receives from the receiving provider. Delayed treatment, waiting time, missed appointments are important reasons for the patient being unhappy with the receiving provider.
  • Time-consuming diagnostic procedures – The patient may have to repeat all the diagnostic tests taken earlier in the new hospital. This is time-consuming and costly for the patient. The referral does not help the patient with an earlier treatment but only delays it.
  • Patient as a communication channel – The patient is made to communicate between the referring and the receiving providers. It may be required for missing patient information, diagnostic test results, patient medical history, allergies, etc.
  • Patient insurance coverage – The process of pre-authorization is done by the referring provider. If not done properly, the patient may have to pay for the treatment in spite of having an insurance.

What challenges do providers face in the existing patient referral management workflow?

  • 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.
  • Patients moving out of the network – When physician refer their patients out of their network, patients leave their network. In general, providers referring patients out of their network are less likely to have access to availability, location, network affiliation and insurance information. This is not the best options for a patient. Further, lack of information within a delivery system can result in missed opportunities to connect a patient with a provider with similar expertise who could see the patient sooner, which improves patient satisfaction and retention, as well as care coordination.
  • 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 the referral information 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 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.

HealthViewX Patient Referral Management Solution at your aid

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 can automatically pull referral orders from EMR/EHR in real-time. It also helps in configuring all other referral coordinator workflows and tasks with maximum automation. Thus our platform can 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.

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.