Monthly Archives: September 2018

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.