Tag Archives: fqhc

Understanding the scope of Chronic Care Management and what is required to make it profitable

Approximately 71% of the total healthcare spend in the United States is associated with care for Americans with more than one chronic condition. Among Medicare fee-for-service beneficiaries, people with multiple chronic conditions account for 93% of total Medicare spending.

It is said that a large percentage of these expenses are associated with acute care and emergency visits that could be prevented by earlier intervention. Patients who have multiple chronic conditions require ongoing medical attention. Putting further emphasis on health programs with an eye towards preventing and controlling chronic disease is one of the ways to address such costs.

The Centers for Medicare & Medicaid Services (CMS) recognizes Chronic Care Management (CCM) as a critical component of primary care that contributes to better health and care for individuals.

What Physicians need to understand?

Medicare’s Chronic Care Management program has a primary clinical goal which is improving the health of Medicare patients with two or more chronic conditions expected to last at least 12 months or until the death of the patient, and who are at significant risk of death, acute exacerbation/decompensation, or functional decline. In addition to understanding the service-level parameters, pay levels, CCM codes.

PCP’s and other health organizations who provide CCM services need to understand how to effectively bill for CCM in order to profitably achieve that goal.

Some of the basic preconditions that providers must satisfy are:

  • the provider is required to complete an initial face-to-face visit
  • obtain verbal or written consent from the patient, and  develop a comprehensive care plan in the electronic health record
  • provide 24/7 access to care
  • use a certified EHR to aggregate all patient health information
  • establish continuity through a designated care team member who works with the patient to implement a dynamic plan that spells out the patient’s key prevention and treatment goals and strategies

Who all can provide CCM services?

Additionally to physician offices, Chronic Care Management Services can be provided by

  • Federally Qualified Health Centers
  • Rural Health Clinics
  • Critical Access Hospitals

And the following healthcare professionals can bill for CCM services

  • Physicians
  • Physician Assistants
  • Nurse Practitioners
  • Certified Nurse-Midwives
  • Clinical Nurse Specialists

Non-physicians must legally be authorized and qualified to provide CCM in the state in which the services are furnished.

Why provide Chronic Care Management Services?

It benefits both providers and patients. Patients will receive better-coordinated care thereby preventing hospitalization and re-admissions. Providers will not only receive payments for providing care but also improve practice efficiency, compliance, patient satisfaction, and health outcomes. Practices, large providers, and health systems can add net new recurring monthly revenue. 

How do physicians and other providers document the CCM services that are provided?

Some practices do the tracking manually, while some of the practices have CCM documentation built into their EHR’s. Other practices implement specialized CCM software to track time and ensure all the CCM requirements are met. Some of the CCM software has the ability to track not only the documentation but also send reminders or notifications to the patient, provider and other healthcare professionals involved in patient care. 

How to make CCM profitable?

Chronic care management requires 24/7 access to care. Practices take different approaches to meet this requirement to provide better care coordination. Some practices hire additional staff and some opt for a solution to automate the end-to-end process to cut down on additional staff expenses. Considering healthcare IT will not only cut down on additional expenses but will also make CCM more effective and efficient.

Talk to HealthViewX solution experts to understand more about HealthViewX CCM solution and make your CCM profitable. 

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

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.