Tag Archives: medical referrals

How to build a strong referral network for your medical practice

Health systems and hospitals need to build a high performing and strong referral network as they serve a large community. For most health systems, out-of-network providers/physicians are the main sources for new patients. Hence in today’s highly competitive healthcare market, it is crucial for the health system to build, strengthen and maintain these referral relationships to have a strong referral network.

A strong referral network would need patients, referring physicians and receiving providers to keep a healthy network going. A referral solution has the potential to build a strong referral network. 

Here are some reasons as to why you need a solution to build a strong referral network 

  • Health systems need to reduce referral leakage and ensure they don’t refer patients out of their network
  • Referral coordinators have to ensure timely scheduled appointments for their patients 
  • Health systems need to reduce their no-show rates
  • Referral coordinators need to coordinate care between the internal and external providers for better patient outcomes.
  • Hospitals / Health systems need to create and manage a high performing referral network 
  • To obtain more complete and detailed analytics to improve their patient inflow
  • Track patient status at every stage and ensure referral loop closure 

Healthcare providers need to adopt healthcare IT and embrace interoperability. Therefore, the only way to build this strong referral network is to identify and implement the right referral solution for your practice. 

HealthViewX Patient referral management solution can bring in the following benefits for the health systems and help strengthen your referral network

  • Reduced patient no-show rate
  • Reduced referral leakage
  • Increase operational efficiency
  • Patient satisfaction
  • Increased revenue
  • Streamlined referral life cycle management

Making small changes in the way health systems handle referrals will help to retain the patients within the network. Thus, retaining patients within the network, giving quality care will lead to better clinical outcomes.  HealthViewX patient referral management solution acts as a bridge and enables seamless communication between the referring provider and the receiving provider. It helps in making meaningful decisions on the referral process thus making the change that the health system requires today.

Staying ahead in healthcare technology is imperative as it will bring massive benefits to the day-to-day operations and can empower the practice as a whole. A more streamlined process can lead to patient satisfaction, happier referral sources and patients thus making the network strong through quality care.  Once the entire referral process is fine-tuned providers can fully focus on patient care and relationships with referral sources.

Optimizing referral management will help large health systems and hospitals improve overall efficiency and referral network. Data analytics feature will help providers to understand –  the referral patterns, the highest referring source, the lowest referring provider, no-show rates, referral leakage, missed appointments, etc. HealthViewX works with each of its clients to understand their current challenges in the referral system and tunes the referral process to overcome these challenges and build a strong referral network.

HealthViewX patient referral management is highly customizable and is used by leading FQHCs, Large Hospitals, Dental Universities, and Specialities. Do you want to build a strong referral network?

 Schedule a demo with HealthViewX referral management solution experts today! 

Referral Management Solution Is The Need Of The Hour For Large Hospitals

With the ever-evolving healthcare setting and exponential developments in health IT,  many choices need to be made by hospitals/health systems to provide their patients’ with quality care. Health systems are struggling to manage their clinical, operational and monetary challenges. Most importantly, it is necessary to orchestrate care teams’ workflow movements to be able to demonstrate meaningful use. This is the key to improving patient care and the ability to make better-informed decisions. A lot of providers are already adapting to smarter and new healthcare technologies to shape the future of healthcare.

Factors like sustainability, patient-centricity, care delivery, HIPAA compliance, digital health technology, etc. should be kept in mind before choosing any IT solution. Referral Management Solution is one such solution that is the need of the hour and it has to be chosen with utmost importance. Moving from volume-based to value-based care model will require building a solution to manage higher patient referral volumes, to ensure patients’ receive care within their referral network, track referrals, close referral loops, study dashboards and analytics for meaningful use, etc.  

There are a lot of benefits a referral management solution can bring to referring physicians, patients and receiving physicians: that includes, improved operational efficiency, reduced referral leakage, increased referral loop closures, increased revenue and patient satisfaction.

There are several other reasons why a referral management solution is required to manage patient referrals. Hospitals face numerous challenges in their referral process such as operational inefficiency, improper communication among providers, lack of coordination, missed referral loop closures, increased no-show rates, time consumption, etc.

Below are some alarming stats that show the need for a referral solution for hospitals

  • 46% of faxed referrals never result in a scheduled appointment.
  • 55% of specialist visits are unnecessary.
  • There is an annual leaked income of $900k per physician employed.
  • 50% of referring physicians do not know whether their patients actually see the specialist.

In addition, hospitals participate in passive referral management:

  1. Physician informs the patient about the need to see a specialist.
  2. Referral coordinators may not reach out to the patient to get an update to see if the patient had visited the specialist.
  3. Follow-up or update from the customer is completed only during the next visit.

Active referral management enables both provider and patient-driven processes to be managed by referral coordinators. It ensures maximum efficiency, finds the right provider for the patient, identifies referral patterns, improves stakeholder communication, reduces referral leakage, decreases lead time, improves completion rates, ensures closure of the referral loop and satisfaction of the patient.

Pitfalls in choosing the right Referral Management Solution:

Even though there different referral management software with an array of features in the market, it often becomes frustrating to choose the right solution for your hospital. So before zeroing in on the solution, a detailed analysis of your current challenges in the patient referral process has to be carried out. Later mapping to the required features of the solution will be the best choice.

Health Systems need an end-to-end interoperable referral solution to track their patient referrals throughout the process until the referral loop closure. The solution should streamline and enable seamless communication among all stakeholders’ involved in-patient care.

Some of the benefits you can see when using patient referral software are

For the providers:

  • Reduce referral leakage and improved operational efficiency
  • Seamless communication
  • Multi-channel integration
  • Manage and track referrals
  • Meaningful engagement
  • Effective diagnosis and treatment

For the patients:

  • Prompt diagnosis
  • Save time and money
  • Better outcome

HealthViewX Referral Management Solution was created with the potential to solve all the challenges faced by enterprise hospitals in their referral process.

HealthViewX Referral Management Solution helps to send and receive referrals securely and seamlessly, provide quick access to patient data, fix appointments, send notifications and alerts, and share information throughout to ensure closure of referral loop. A 30-minute demo with our team will help you know how effective our solution can track and manage the referral life cycle. To know more schedule a demo with us.

 

6 Powerful Applications Of Artificial Intelligence In The Healthcare Industry

Artificial Intelligence in Healthcare

Artificial Intelligence has laid the foundation for many stunning innovations that have simplified our lives. The term is used to describe the intelligence demonstrated by machines. AI complements human intelligence in a beautiful way, allowing us to achieve more with the information we have. The implementation of AI in healthcare has changed the way in which patients were treated. The most common implementations of AI in healthcare are medical imaging diagnostics and virtual health assistants.

The following are the six interesting applications of AI in the healthcare industry,

1. Robot doctors are real now

Let’s say you are going to see the doctor. Will you not be taken aback to see a robot attending you? In 2017, a robot passed the medical licensing exam in China. It’s an AI device that automatically captures and analyzes the patient’s information. It can even provide an initial diagnosis, which would help in future treatment.  In simple terms, robot doctors can be compared to chatbots that give customer service to people visiting the website. Is this robot ready to go into solo practice? Not quite. The robot will not treat you. But it’s absolutely capable to take care of the first doctor-patient encounter. It takes the patient’s information and processes it. Then it makes logical suggestions to the doctor, so it can help them identify the issue and proceed to adequate treatment. It takes the patient’s information and processes it. Then it makes logical suggestions to the doctor, so it can help them identify the issue and proceed to adequate treatment.

2. Robot dentists can operate alone

The robot doctor in the discussion above won’t replace the actual doctors in the office. But a robot dentist can do much more. It is so real and amazing. In this case, we can safely say that the robot is better than a human dentist. Dental implant operations are problematic and prone to human errors. The robot can avoid such problems and overcome the shortage of dentists in many countries across the world. The hour-long procedure took place in China, in August 2018.
The robot carried out the implant surgery autonomously. The medical staff was present, but they only supervised the process. It must have been really scary for the patient. But the fact that robots can perform dental surgery with a minimal margin of error is impressive. Even more impressive: the teeth that the robot implanted were created with 3D printing technology. We’re getting far, people!

3. Artificial Intelligence has made melanoma detection easier

Melanoma is hard to detect with the human eye. Early detection is primarily important, though. It literally saves lives. Artificial intelligence gives new hope. It has the potential to distinguish benign from malignant moles. The computer program analyzes the patterns of various skin conditions. Through a self-learning system, it will be able to make a difference between various dermatological conditions. This technology is yet to be implemented into diagnostic practices. Still, the researchers are very optimistic about it. AI can outperform human doctors in recognizing skin melanomas, and the technology is likely to get better.

4. AI can reduce non-adherence to medication issues

Non-adherence with prescription medication is a serious healthcare issue. It is the patient’s inability to follow the treatment prescriptions. They may decide not to start treatment, or they may decide to use doses different from the prescribed ones. They may also discontinue the treatment because they decided so.
Artificial intelligence is making a huge difference in this aspect. Healthcare practitioners can use AI to reduce systemic waste by identifying patients who are prone to non-adherence with their prescription drugs. The program analyzes several variables, such as age, gender, payer type, geography, and out-of-pocket costs, so it can predict the possibility for non-adherence.
With this information, they can identify patients who need additional support to follow the recommendations for treatment. They will focus more on communication and they will explain exactly why it’s important for the patient to follow recommendations.

5. Effective Image Analysis with AI

Medical imaging is the foundation of proper diagnostics. Image analysis, however, is time-consuming and tricky for doctors. It can take hours for them to compare 3D medical scans and analyze the changes. It’s a good thing that we’re making progress here. In June 2018, a team of MIT researchers came out with the news that they developed a machine learning algorithm, which analyzes 3D scans up to 1,000 faster than doctors. This is incredibly important, especially for surgeons. Sometimes they have to bring patients back to the operating room if they notice that they haven’t completely removed a tumor after surgery. The ability to read medical images faster is life-saving. With this technology, they can practically study changes in real-time.

6. Robot-assisted surgeries are happening

We are still waiting for the day when large incisions during surgery will be part of history. Thanks to robots, that day is getting close. Da Vinci Si is a surgical robot that’s as minimally invasive as possible. The technology uses information from past surgical experiences to improve its techniques. The robot contains 3D cameras and a variety of surgical instruments, which replicate the movements of the operating surgeon.
With this, the surgeon gets an opportunity to perform complex procedures with greater precision and more control over the instruments. They control the robot’s arms from a computer console positioned near the operating table.

Future of AI

With all the implementations described above, under careful human oversight AI can reduce human errors in healthcare, and make the providers more effective. The good news is that currently, AI is being used under careful human oversight. The day for robots that operate autonomously will probably come. But by then, we’ll be absolutely confident in their capacity. Despite the concerns, the growing implementation of AI in the medical industry is part of the inevitable progress.

6 Reasons FQHCs and CHCs Benefit from Patient Referral Management Software

Federally Qualified Health Centers and what do they do?

A Federally Qualified Health Center (FQHC) is a community-based organization that provides comprehensive primary care and preventive care, including health, oral, and mental health/substance abuse services to persons of all ages, regardless of their ability to pay or health insurance status. Thus, they are a critical component of the health care safety net. FQHCs are called Community/Migrant Health Centers (C/MHC), Community Health Centers (CHC), and 330 Funded Clinics. FQHCs are automatically designated as health professional shortage facilities. FQHC is a non-profitable, consumer-directed healthcare organization. FQHC serves the underserved, underinsured and uninsured people, and provides them with access to high quality and preventive medical health care. FQHCs were originally meant to provide comprehensive health services to the medically underserved to reduce the patient load on hospital emergency rooms. 

FQHCs include 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 also include outpatient health programs or facilities operated by a tribe or tribal organization or by an urban Indian organization. FQHCs are paid based on the FQHC Prospective Payment System (PPS) for medically-necessary primary health services and qualified preventive health services furnished by an FQHC practitioner. Their mission has changed since their founding. Their mission now is to enhance primary care services in underserved urban and rural communities.

FQHCs and CHCs provide critical primary care services to tens of millions of people each year in this country. Their role in the front-line of healthcare makes them important entry points for patients entering the broader healthcare system. Let us see how these organizations use patient referral management systems to leverage their role as an important source of patient referrals and improve the care they can provide for their populations.

  1. Minimized out-of-pocket expenses for patients

For the longest time, organizations managed outbound referrals based largely on each referring PCP’s preference for individual specialists. This worked better in the open, PPO networks that were more common in the past. Now, however, narrow networks and varied plan participation by specialists can lead to high out-of-pocket costs and irate patients if they are referred to the wrong specialist. Referral management software solves this problem.

  1. Creating a more integrated provider network

Today, many organizations recognize their referral stream is a valuable point of leverage when advocating for patient populations. FQHCs and CHCs want better customer service, quicker appointment times and better care coordination with specialists. It is high time they recognize a referral management system which will allow them to organize, quantify, and eventually shape their referral stream. Many primary care organizations have found that pleas for better coordination with specialists go unheard until a change in referral patterns was included. When a referral management system is implemented, the network is more integrated and easy to handle.

  1. Increased patient advocacy and access to care

Patients being referred from FQHCs and CHCs often have limited health insurance or no insurance coverage at all. It is a tremendous challenge for referral coordinators to find specialists who accept patients’ insurance plans (if they have insurance) and are willing to accept uninsured patients or underinsured because providers report they have much higher no-show rates, which means a loss of income for the specialist. Simply telling a patient they need to see a specialist and perhaps giving them a name and phone number isn’t enough to make a referral visit happen; it’s just the first step.

A referral management solution allows the clinic to curate and maintains a set of specialist resources that referring providers know both accept patient insurance plans and provide excellent care. This is a very essential step as it improves patient experience of the referral and increases their access to quality care.

  1. Chronic care management revenue optimization

Many FQHCs and CHCs participate in programs such as Chronic Care Management (CPT Code G0511 or 99490) or 340B. Through the clinic’s ability to track and coordinate referrals, it leads to increased revenue for the clinic, which helps them continue to care for uninsured and underinsured patient populations.

  1. Better referral workflows

Many primary care settings lack a centralized or coordinated method for managing referrals. It is common to learn that existing referral management involves the use of spreadsheets and is entirely manual. Referrals are send based on individual provider’s preferences. It is because referring providers don’t know who is in the network, nearby, available, and takes the patient’s insurance plan – but they do know who practices good medicine. This can lead to inconsistent patient experiences, more expensive healthcare overall, and deprives the clinic of taking full advantage of the referral volume they are sending into the medical community. With referral management software in place, it is easy to identify providers within the network who perfectly match the referral requirements.

  1. Improved care coordination

On average, one out of five patient appointments at an FQHC or CHC results in a referral. By definition, when a patient receives a referral it means there has been a change in diagnosis and it requires the advice of a specialist. A well-implemented referral management system helps ensure patients get the best possible access to care. It also makes the patient journey from primary care to the specialist as seamless as possible, even when providers are employed by different organizations or independent. Communication and sharing of data between different EMRs are highly impossible. This is where EMRs/EHRs tend to miss the mark.

Top 6 Reasons Why You Need A Referral Management System Even Though You Have An EMR/EHR

When an organization considers purchasing a patient Referral Management System (RMS), one of the first points management considers is whether or not its existing EMR/EHR can provide the missing functionality with an add-on, or perhaps already does but is not being used.

In general, use cases that are exclusive to employed healthcare providers working within the provider system will favor using an EMR alone. However, once an organization wants to do complex tiering of its networks and/or work with provider resources outside its organization, a Referral Management System becomes critical. 

Below, we provide the top 6 reasons a Referral Management System is a necessary tool for a healthcare system in addition to an EHR/EMR.

6. Referral Management Systems Enable Healthy Provider Network Utilization

A healthy referral network should be able to distribute referrals evenly among comparable resources in a given geography. It is essential to maintain active participation among all the providers in the network. Often a favored specialist at the top of the list keeps getting more and more referrals at the expense of others who might be just as qualified. An effective Referral Management System can provide load-balancing algorithms so that referrals are distributed evenly among comparable providers.

5. Referral Management Systems Provide End-to-End Patient Referral Tracking

Part of the clinical opportunity for referral management stems from the fact that referrals typically occur when there is a change of diagnosis or an escalation in care. As such, a referral is often the first indication that a patient will likely trigger significant downstream consumption. A well-implemented patient referral solution enables an organization to track patients in real-time and better guide patients towards high-quality low-cost care settings. Further, the system needs to encourage specialist staff to report appointment attendance or noncompliance, as well as return clinical notes to primary care offices for better patient care and better patient outcomes.

4. Referral Management Systems Facilitate Real-Time Referral Reporting

The ability to report highly granular referral analytics that illustrates referral patterns is essential for any Referral Management System. Organizations taking on risk as well as organizations optimizing referral patterns need to stay vigilant about network performance and network adequacy. Referral analytics should help organizations identify particular areas of concern as well as provide reporting that impacts referral patterns and facilitates change. Furthermore, robust Referral management software should be able to provide this data within the application itself as well as have the ability to export this data in any suitable format. 

3. Referral Management Systems Create Dynamic Referral List Based on Location

Many organizations must be able to manage referrals across large geographic areas. Indeed, the Service Level Agreements (SLAs) that many provider organizations enter into with payers as part of risk-sharing arrangements have network requirements that dictate how far away a specialist referral can be for a patient. A patient referral management solution can store the SLAs from the different payers, and then generate a geo-specific list of referral resources that can be based on the primary care provider’s location or the patient’s home.

2. Referral Management Systems Create Dynamic Referral Lists Based on Payer Selection or Plan Design

Referral networks tend to have networks within the network, where different payers or insurance plans have preferences or rules where patients can go for care. A referral management solution can generate a referral list for each patient based on the plan each patient carries.

1. Referral Management Systems Connect Healthcare Clinics Across Different EMRs

Once an organization wants to manage referrals across networks (e.g. among affiliates), chances are high that many offices will be using different EMRs. An effective referral management solution will be able to provide workflow and integration solutions that can work across multiple different EMR/EHR vendors and networks. 

How has HealthViewX added value to referring physicians’ patient referral problems?

1) Automating the insurance pre-authorization process 

HealthViewX platform has a payer management module that maintains and manages 

  • Different payer details
  • Modes of prior authorization
  • Direct authorization procedures
  • Payer forms 
  • Online portal links
  • With this information already present, it provides the referral coordinator with the capability to automate 
  • Prior authorization submission
  • Status checks coupled 
  • Fax integration

It simplifies the process of insurance pre-authorization. The referral coordinator need not waste time on the process anymore.

2) Intelligent Provider Match 

Our “Smart Search” feature makes it easy for the referring provider in finding the right provider. It has smart filters and search options that help in narrowing down the specialist based on the requirements.

3) Establishing best practices

After using our HealthViewX Patient Referral Management System, physicians were automatically alerted to

  • Appointments
  • Referral status
  • Patient diagnostic reports
  • Referral completion 

As a result, we can cut down on miscommunications and bridge the gaps between the specialist and the physician community. The system also assembles a patient encounter record from the EMR/EHR and pushes it directly to the physician.

4) Forming a close-knit of trusted referral receiving centers

Our system helps in strengthening ties with the medical community. From a history referral experiences the PCPs can from a close-knit of referral receiving providers. Physicians can now refer patients to hospitals they can rely on. 

HealthViewX Patient Referral Management solution helps the referring physicians in handling and managing their referrals. Are you an inbound referral heavy practice looking for an end-to-end referral management solution? Schedule a demo with us. Our patient referral management experts will guide you through our HIPAA compliant solution.

5 Healthcare Industry Trends To Watch Out For

With every passing day, the healthcare industry is growing and becoming better. In order to keep up with the huge demand for medicine and treatments, researchers are inventing new systems and technologies. So what are the healthcare trends to watch out for in 2019 and beyond?

The number of baby boomers who retire and come under Medicare or Medicaid is increasing every year. At the same time, medical experts are making unbelievable achievements in treatments and medicine. So it is difficult to predict the number of inventions in the future. But one thing we know for sure is that the healthcare industry has a bright future.

Due to the rapid advancement in technology, the healthcare industry has grown quickly to serve a huge number of people across the world. Despite the uncertainty in the future, it is possible to predict by looking at the medical learning centers because that’s where most of the ideas originate.

So, let us go into the top 5 healthcare trends to watch out for!

  • Electronic Medical Records/Electronic Health Records

Electronic Medical Records (EMRs) are the top of the list. But these are not new so how can it be a trend? Most of the health institutions across the U.S. have adopted the use of electronic medical records and it has positive effects.

According to Assignment Masters, it is necessary to have patients’ records in digital form to not only access these easily but also convenient for medical experts to communicate and share information with other experts in a different area. With these records, any physician can access the patient’s medical history in seconds and this allows him or her to make informed decisions when treating the patient.

Although EMRs have been around for a while, it took some time for health systems across the U.S. to embrace and implement it. Today, most of the health systems use electronic medical records. 

In 2019, we can see how technology will continue improving patient care in the long-term. With digital records, the medical expert can devise effective treatment plans anytime.

  • Smartphones allowed in medical classes

The second trend is all about how technology will not only change systems in hospitals but also in the class. Today, technology has changed how medical experts interact, gather information and make decisions. It has also changed the way medical students are trained. Today, healthcare workers don’t get in trouble for having smartphones and Edugeeksclub in class. In fact, they are encouraged to use these devices to improve their learning methods.

Teachers have also changed their teaching methods. They have reported having an easier time teaching using new equipment and software. It allows them to share important information easily and fast as compared to the traditional lecture which was difficult for the teacher and boring for the student. Students can also collaborate easily through these systems and this gets them prepared for real-life experiences.

  • Artificial Intelligence

It is impossible to discuss the future of the healthcare industry without thinking about artificial intelligence. Artificial intelligence will change and improve healthcare in many different ways. In general, artificial intelligence will open the avenue for human beings and technology to connect. Through this connection, it is easy to monitor and analyze the activity of human beings all over the world easily.

With artificial intelligence, healthcare providers will have the best tools in their hands to treat patients. For instance, using this technology, healthcare providers can easily offer their services in places where there is a shortage of doctors without being there physically. Some experts are predicting that treatments such as radiology will be enhanced to a point that healthcare providers will not need to take tissue samples from patients.

According to Essay Shark, artificial intelligence in the health care industry will increase by $1.7 billion and this is expected to improve performance and productivity by ten to fifteen percent in the next few years. Artificial intelligence will improve efficiency, save time and money and improve the experience of the patient.

  • Medical devices

Technology has made it possible for patients to consult their doctors without having to visit them. Today, doctors and patients can video chat any time they want. After communicating with the patient and analyzing his or her records, the healthcare provider can easily make informed decisions. This is good news for patients who are very old or for people who cannot get out of their houses.

With improvements in technology, our healthcare system will also improve. Medical experts have spent a lot of time and energy innovating medical devices that will revolutionize the healthcare industry. With these devices, you don’t have to wait for days or hours to get your results. They are fast and efficient.

These machines are not only convenient for patients but also to health providers. Their quality of service determines health or sickness and frustration. 

  • Improved quality of service

All technological advancements are centered on improving the experience of the patient. In every profession, the experts are paid based on the quality and quantity of service they render. Technology allows healthcare providers to measure their outcomes based on the hours they log in and the health outcomes of their patients.

It also makes it easier for healthcare providers to determine which type of treatment works best and how to get the best outcome out of them. Tests can be performed quickly and accurately. Medicine and other forms of treatment are available. In the coming years, patients will receive the best care that man has been dreaming and working towards to for thousands of years.

The health care trends discussed above are just but a fraction of what we should expect in the near future. With technology advancing at a rapid rate, we look forward to quick and efficient medical tools and treatments. As technology advances, it will reduce the burden on healthcare practitioners and they will be able to deliver the best quality of service.