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.