Monthly Archives: November 2019

The Role of Referral Management in Value-Based Health Care

What is Value-Based Care?

Value-Based Care is a care delivery model in which healthcare providers are paid based on the health outcomes of the patient. Value-based is a quality-based care model that drives “better health for all” and benefits the community, providers, and payers as a whole. Value-based care helps healthcare providers by helping patients improve their health and reduce the prevalence of chronic illness. This care model is a potential swap for fee-for-service reimbursement based on quality. The providers are paid based on the health outcomes of the patients and are rewarded for helping patients’ improve their health. The ultimate goal of value-based care is to optimize the care for the patient population.

What are the benefits of Value-Based Care?

For Patients – Reduced cost and better health outcomes

For Providers – Better patient satisfaction and improved care efficiencies

For Payers – Stronger control on costs and lowered risk

For Community – Reduced spend on healthcare and improved overall wellbeing

What is a Patient Referral Management Solution?

Patient Referral Management Solution is a patient referral tracking tool for end-to-end referral communication and management. The solution is designed for healthcare organizations to enable them to provide better care with a well-orchestrated customizable workflow. Its primary goal is to enhance and streamline interaction among all care providers involved in patient care for better patient outcomes.  

Role of Patient Referral Management Solution in Value-Based Care

Right from small to large, healthcare providers face a lot of challenges in their referral process. Poor communication and referral workflow among providers lead to diminished care quality and patient experience. Lack of timeliness of the information and inadequate patient information or reports all contribute to poor care continuity, patient dissatisfaction, and poor health outcomes.

A well-orchestrated and automated patient referral solution has the potential to transform referral workflows and help providers improve their patient health outcomes. It helps provide value-based care through better care coordination throughout the care journey. A referral management solution can help improve efficiency, reduce time spent on redundant tasks, cut down on overhead costs, reduce referral processing time thus helps both providers and patients. Streamlined workflows lead to better patient outcomes.  The prime objective of the solution is to improve patient-physician interaction and provide value-based care for better patient outcomes.

Why is Referral Management crucial for Healthcare Providers? 

Referral Management is very crucial for healthcare providers to track and manage referrals, and ensure better patient outcomes. Referral management is essential when

  • referring and receiving providers have different EMRs/EHRs
  • healthcare providers are coordinating between in-network and out-of-network providers
  • health systems are looking to improve patient health outcomes and reduce no-show rates
  • providers want to increase revenue and reduce operational cost
  • health systems want to focus on quality care by using value-based care models 

A major challenge in the current referral process is that most EMRs are not equipped enough to handle the end-to-end referral process. A referral management solution helps healthcare providers to track and manage their end-to-end referral process with complete transparency. The solution helps streamline workflow, reduce clinical errors/delays, cut down the processing time by automating multiple touchpoints, and obtain strategic data/facts for informed decision-making. The prime objective of the solution is to enhance communication among healthcare providers involved in patient care.

By leveraging technology the healthcare industry can provide value-based care for their patients and better patient experience. An end-to-end patient referral tracking ensures timely care, improves care coordination and better outcomes. HealthViewX referral management solution is designed to suit any practice, customized to meet user requirements, and enables data-driven decision support, and provides real-time insights of patient-reported data to promote better care delivery. Schedule a demo today to understand more about our HIPAA Compliant SaaS-based referral solution from our experts. 

Advantages FQHCs Gain From A Patient Referral Management Solution

What is a Federally Qualified Health Center?

 A federally qualified health center (FQHC) is a community-based healthcare organization that provides high-quality primary care and preventive care for people of all ages, regardless of their ability to pay or health insurance status, providing health, oral and mental health/substance abuse programs. Federally qualified health centers are also called Community Health Centers (CHC), 330 funded clinics or Migrant Health Centers (MHC).  FQHCs were originally intended to provide the medically underserved population with quality care to minimize patient load in hospital emergency rooms. FQHC provides access to high quality and preventive medical health care to the underserved, underinsured and uninsured people. 

FQHCs embody community health centers, migrant health centers, health care for the homeless health centers, public housing primary care centers, and health center program “look-alikes.” They additionally embody outpatient health programs or facilities run by a tribe or tribal organization or by an urban Indian association. FQHCs are paid in compliance with FQHC Prospective Payment System (PPS) for medically-necessary primary health services and qualified preventive health services furnished by an FQHC practitioner. Their mission has modified since their founding. Their mission now is to reinforce primary care services in underserved urban and rural communities.   

Community health centers or federally qualified health centers provide critical primary care services to tens of millions of people each and 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 technology alone can provide them with the ability to differentiate themselves from their competitors, and help them deliver quality care to their patients, and close referral loops efficiently.  A 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 in patient 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 time-consuming and tedious. Making the referral workflow simple 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. Right from referring the patient to the right provider, to insurance prior authorization, scheduling appointments, sending reminders, updating the patient information back into the EHR, etc. all 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.