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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.

How Can Automated Referral Workflows Increase Patient Satisfaction?

Today’s healthcare model demands that services be centered around patients. This model faces additional challenges when care needs to be coordinated among multiple providers. Between 1999 and 2009, the number of primary care visits resulting in referral has increased by 159%. 

Problems with the existing referral workflow

Research strongly indicates that referring physicians need to improve the quality of information they provide to consulting physicians. When surveyed, 63% of PCPs and 35% of specialists report dissatisfaction with the current referral process because,

  • Paper referrals often do not provide adequate information
  • Consult reports are not delivered in a timely manner
  • Many referrals do not even include transmission of information, either to or from specialists

Consequently, PCPs are always not aware if a patient has seen a specialist. To add to this, up to 80% of ACO clinicians report the lack of interoperability among data systems is the greatest challenge. It happens particularly when they are attempting to locate information from out-of-network providers. Physicians consistently indicate that improvements are needed in the referral system to optimize patient care.

Why are automated workflows important?

Did you know? Among all patient referrals from PCP to the specialist, it is estimated that only half as many patients show up for their specialty care appointment. Furthermore, “self-referral” patients who see specialists without a recommendation from a PCP are associated with higher patient dissatisfaction and poorer continuity of care with the primary care doctor. A study states that 70% of specialists rate the referral information they receive from Primary Care Providers as fair or poor. 

In a patient-centric healthcare environment, patient satisfaction is the major concern of many practices. An automated referral workflow provides a way for physicians to ensure that patients are getting the care they need when they need it. As PCPs refer more patients to specialists each year, coordinated care and automated referral workflow become an urgent issue for both independent and hospital-based practices.

How can an Electronic Referral System help?

Information Technology enables patient referral workflow automation. HealthViewX Patient Referral Management System simplifies the process and closes the referral loop on time.

  1. The Primary Care Provider (PCP) identifies the need for a referral and initiates the same through the EHR system.
  2. The referral coordination team then validates the referral and does the insurance pre-authorization with the help of HealthViewX solution.
  3. The Intelligent Provider Smart Search feature of HealthViewX Patient Referral Management System helps in finding the right specialist or imaging center easily.
  4. The referral coordination team then sends the referral with the necessary documents to the relevant specialist or imaging center through the HealthViewX platform.
  5. The receiving provider gets notified about the referral and can schedule appointments with the patient.
  6. The patient and the receiving provider get reminders of the appointments thus reducing no-show rates.
  7. The referring provider is also notified about the status of the referral and how it is progressing. HealthViewX timeline view makes tracking and managing the referral lifecycle easier.
  8. HealthViewX tracks and sends reminders to the receiving provider to update the diagnosis, treatment recommendations, care plans in the referral.
  9. HealthViewX makes it easy for the referring provider by automatically updating this information back to the EHR system.
  10. Thus the HealthViewX solution closes the referral loop on time and helps in easy monitoring of the same.

Impacts of implementing an electronic referral management system

After the implementation of an electronic referral system, providers have observed, 

  • Enhanced direct communication between PCPs and specialists regarding their mutual patients
  • Better appointment tracking
  • Improved access to specialty care
  • Increased consult report compliance and follow-up

In addition, referral systems appeal to front-office staff because of its intuitive user interface and human-centered design. When providers can easily access needed information, they’re empowered to deliver better care.

Benefits of automating the referral workflow

  1. Increased Medicare reimbursements –  Medicare considers closing medical referral loop as a benchmark for giving reimbursements. Closed medical referral loops increase the opportunities for Medicare reimbursements for referral marketing.
  2. Streamline referral management – With HealthViewX Patient Referral System in place, the referral workflow is automated and streamlined.
  3. Improved patient care – Reduced waiting time gives patient satisfaction thereby improving the care quality.
  4. Increased productivity – Reduced operational time improves the efficiency of the patient referral system.

 

Reference

3 Ways Through Which A Practice Can Enhance Patient Experience And Improve Patient Engagement

Patient experience is not just about the quality of care measurements and outcomes. Today, there are about 10 aspects that define the patient experience, and each one has its own impact to attract and retain patients within the network.

Patient experience and engagement can be defined by the following aspects,

  1. Meeting with a doctor
  2. Wait time
  3. Billing
  4. Scheduling appointments
  5. Appointment follow-up
  6. Staff interactions
  7. Pharmacy
  8. Online reviews
  9. Social media
  10. Website

Let us explore a few tips that will enhance the patient experience, improve patient engagement, drive better outcomes and keep staff engaged. We know patients actively involved in their health tend to have better outcomes, report higher overall satisfaction, and experience lower health-related costs.

Enhancing and transforming the patient experience and providing first-rate, patient-centered care revolves around the consistent development of processes to meet patients’ expectations and needs. Understanding patients’ preferences and priorities will allow practices to identify and optimize opportunities to increase comfort and reduce suffering which will ultimately strengthen the patient-provider relationship.

Let us first define exactly what patient engagement is and break down top-level strategies that practices can use to stay connected with their patients outside traditional clinic walls.

What is the difference between patient engagement and patient experience?

The patient experience is influenced by the perception of the care they received. Ultimately, patient experience represents the overall satisfaction of their personal experience with the practice, which, more often than not, is beyond control.  

Patient engagement, however, relates to the way a patient mobilizes their healthcare experience. What actions do they take that allow them to take an active role in their healthcare? What tools, technologies, and programs are available to encourage patients, caregivers, and families to play a more engaged role in administering their long-term health and wellness?

To improve patient engagement, a practice must recognize that engaging with patients is a triangular synergy between the physician, the patient, and the practice. It is about encouraging interaction between patients and providing meaningful opportunities for your patients to engage in the ways they know and are comfortable with.

1) Keeping patients engaged after they leave

Patient engagement is no rocket science. Patients want any practice to be accessible. They desire simple ways to schedule appointments, and perhaps most important of all, they want transparent and straightforward billing.

Technology has its purpose, but nothing can substitute for genuine interpersonal communication. Compassion and empathy are not something patients can get from AI or an app; they are, however, things the practice and their staff can use to promote greater engagement.

If a practice has the latest technological gadgets, it doesn’t mean that they can check patient engagement off your to-do list. Improving patient engagement is about that personal touch, human connection, feeling like taking an active role in managing healthcare delivery.

Therefore, how can a practice engage their patients? The answer lies in the space between a doctor’s visit and the following chapter in a patient’s care.

Patients have climbed on the digital bandwagon and ready for technological engagement. Patients already interact daily with different technologies, so practice should consider employing those to boost engagement. Here are some ideas that will work:

  1. Smartwatch health data monitoring
  2. Real-time educational opportunities through the website or Alexa-like devices
  3. Push notifications to remind patients to exercise, pick up their prescriptions, or invite them to special events or seminars

To impact patient experience, satisfaction, and engagement, it will be critical to concentrate on the tiny adjustments within the practice’s workflow that will have a significant impact on the patient.

2) Leverage Artificial Intelligence

Three-quarters of aging households are expected to adopt voice-assisted technology by 2020 making artificial intelligence (AI) the tech frontrunner to enhance patient engagement.

Not inconceivable is the presence of an Alexa like Bluetooth speaker running through exam rooms, performing like closed-loop HIPAA-compliant systems. Patients would be able to ask questions related to their file and diagnosis, change the TV channel or dim the lighting in the room.

Virtual reality (VR) can also drive patient engagement. Some hospitals in California are employing VR to show patients how specific brain surgeries will be performed, thus elevating patient satisfaction scores as well as reimbursements. There’s a real possibility of home care and wound care with patient and provider interacting one-on-one from different locations is just around the corner.

3) Remember who you are talking to

The language also has a great impact on patient engagement. Instead of focusing on “adherence and compliance,” the practice should try to discern the underlying social or environmental factors hindering a patient from complying with medical recommendations.

Why is a particular patient unable to comply? A practice must take the time to connect with and understand their patients. They need to have conversations, put themselves in their patients’ shoes, and then find methods to boost patient engagement and enhance overall patient satisfaction.  

Roughly 40 million U.S. adults read at a junior high school level. However, most healthcare directions are written in much more complex language (usually in tiny fonts) which cause confusion and increase non-compliance, particularly among aging populations. To fully engage patients, practices must make sure they can comprehend the instructions we’re giving them.

What does it all mean?

At the end of the day, an engaged patient has superior outcomes, reduced costs of care, and greater satisfaction overall. The more a practice develops a culture beyond the clinical atmosphere to one that connects both patient and provider through a digital culture of wellness, communication and personalization, the more the patients and the practice will benefit.

Patients demand experiences be more custom to them, and one of the best ways to deliver is to keep them engaged outside of the office, leverage technology and utilize the proper language to drive your points and treatment plans home.

Relevance and use of patient referral management software to FQHCs and large enterprise hospitals

Money inflow is very important for medical practices. Without a constant source of revenue, medical practices cannot pay bills, pay employees or take care of patients. Importance of revenue is no different for Federally Qualified Health Centers, Community Clinics, Large Enterprise, and Specialty Hospitals. One way to ensure constant revenue is by retaining patients within the hospital network and providing optimal patient care. To do this efficiently, hospitals use patient referral management software.

Role of FQHCs:

FQHCs play an important role in supporting their community and providing care services to the underserved. Due to this, they may experience financial issues at uncertain times. When budgetary resources are strained, it is critical for an FQHC to

  • Operate with maximum operational efficiency
  • Preserve financial security
  • Maintain staffing levels to continue operations

Inefficient and improper business processes will lead to patient dissatisfaction which will result in patients leaving the practice. FQHCs must concentrate on

  • Maximizing their business and staff efficiency
  • Minimizing financial risks

The relevance of patient referral management software to FQHCs

It is important for FQHCs to take good care of their patients. Factors such as waiting time, improper schedules, referring to the wrong provider, etc create patient dissatisfaction. Using referral management software, providers can access patient health records, schedule appointments and choose providers based on diagnosis and preferences. FQHCs can reduce patient-show rates, decrease referral leakage and also improve patient satisfaction.

FQHCs traditionally prefer working with EMR/EHR systems because they are comfortable with it. An EHR/EMR system has many advantages but when it is complemented with a Referral Management software practices can experience many more benefits.

The relevance of patient referral management software to Enterprise Hospitals

The following challenges in the patient referral workflow are common in enterprise hospitals across the USA.

  • Limited provider information – Physicians do not have information about the providers within their network. This is to blame for unnecessary out of network referrals. Providers who refer out of network could avoid at least one-third of these if they had access to more robust information about providers in their networks. Even when physicians have access to their health system’s provider directories, they are not using the directories because they don’t have the level of information that is needed.
  • Inadequate referral information – Even when physicians refer their patients out-of-network, the chances of a successful referral are less. This is because many providers who receive referrals rate referral information as poor. Without referral information, receiving providers cannot treat their patients effectively.
  • Inefficient patient appointment scheduling – For providers who schedule an appointment for the patient, they prefer doing it through the phone to shared electronic health records system. When heavy use of the phone occurs, it is difficult for providers to see capacity in their network to book the next available appointment. So they bypass the network and book the appointment before the patient leaves the office.

For FQHCs and Enterprise Hospitals, additional investment in a patient referral solution is recommended for the following reasons:

  1. Outbound and Inbound Referrals – HealthViewX Referral Management Solution can integrate with both the receiving and referring end. For inbound referrals, it helps in channelizing various sources into one single queue. In the case of outbound referrals, it facilitates integration with the existing system to read the patient data and send out referrals.
  2. Referral Timeline – In HealthViewX Referral Management System, any referral has a timeline, to capture and notify the progress of the referral to all the stakeholders. A referral will be mapped to a status which helps in tracking it better. With this, the providers can always be aware of how the referral is progressing.
  3. Workflow and Task Management – A workflow can be defined by how the referral flow must be(business rules). Tasks can be created to manage referrals by assigning it to the respective person.
  4. Improved communication – HealthViewX Referral Management Solution supports messaging and calling features for the referring and receiving providers to stay connected.
  5. Data Management – The solution is HIPAA compliant and enables secure data exchange of all patient-related documents.
  6. Seamless Integration – The solution can seamlessly integrate with any EMR/EHR/RIS or Third Party application thus providing minimal disruption in the existing referral flow.
  7. Referral History Consolidation – The consolidated data regarding the referrals and the referral history of any patient can be printed as a hard copy at any time in pdf/excel.
  8. Smart Search – HealthViewX Referral Management solution has a smart search facility that helps in finding the right provider for the treatment required.
  9. Referral Data Analytics – Referral data-centric dashboard gives complete data regarding the number of referrals flowing out, the number of referrals in various status, patient follow-ups, etc.

HealthViewX Patient Referral Management solution smooths the referral process and solves most of the inbound and outbound referral challenges for Large Enterprise Hospitals. Do you want to know more about HealthViewX HIPAA compliant Patient Referral Management solution? Schedule a demo with us.

FQHC Statistics – Growth, Region, Performance and Revenue – Federally Qualified Health Centers across USA

FQHCs as defined by Medicare and Medicaid

According to Medicare and Medicaid statutes, an FQHC is a health center that receives federal funding under Section 330 of the Public Health Service Act to provide comprehensive primary care services to uninsured and underinsured populations.

Health centers originated under the Economic Opportunity Act of 1964 as “neighborhood health centers”. Section 330 of the Public Health Service Act established the Health Center Program, which provides federal funding for health centers. It also provided federal grants to community and migrant health centers to serve the uninsured. The FQHC program of today was enacted under the Omnibus Budget Reconciliation Act (OBRA) of 1989 and expanded under OBRA of 1990. The legislation provided cost-based reimbursements to health centers for Medicare and Medicaid services specified under Section 330.

The Growth of FQHCs

In the early 1960s, there were only 8 health centers in U.S. Ever since then, the numbers have increased exponentially. By 2001, there were 748 health centers at 4,128 service sites around the nation, serving approximately 10 million individuals.

Federal funding for health centers has increased from $750 million in 1996 to $2.2 billion in 2010. The federal support has increased tremendously over the last 10 years. In 2011, there were 1,128 health centers providing care to more than 8,000 rural and urban delivery sites in U.S. and territories. Today, there are 1400 organizations with 11200 facilities serving about 25 million individuals every year.

Figure 1 - Growth of Health Centers (1980 - 2018)

Figure 1 – Growth of Health Centers (1980 – 2018)

The above chart shows the growth of health centers from the time it started in 1980 till 2018. Also, the chart shows the exponential increase in the number of patients served over the years.

FQHCs in various regions across U.S

State State Code Number of FQHCs
California CA 176
Texas TX 73
New York NY 65
Florida FL 48
Illinois IL 45
Ohio OH 45
Pennsylvania PA 44
Michigan MI 39
Massachusetts MA 39
North Carolina NC 38
Georgia GA 35
Louisiana LA 34
Oregon OR 31
Tennessee TN 29
Alaska AK 28
Missouri MO 28
West Virginia WV 27
Washington WA 27
Virginia VA 26
Indiana IN 25
Kentucky KY 23
New Jersey NJ 23
South Carolina SC 22
Arizona AZ 21
Mississippi MS 21
Colorado CO 20
Oklahoma OK 20
Kansas KA 18
Maine ME 18
Maryland MD 17
Montana MT 17
New Mexico NM 17
Wisconsin WI 17
Connecticut CT 16
Minnesota MN 16
Hawaii HI 14
Iowa IA 14
Idaho ID 14
Alabama AL 14
Puerto Rico PR 14
Utah UT 13
Arkansas AR 12
New Hampshire NH 11
Vermont VT 11
District of Columbia WDC 8
Rhode Island RI 8
Nebraska NE 7
Wyoming WY 6
Nevada NV 5
South Dakota SD 5
North Dakota ND 4
Delaware DE 3
Virgin Islands VI 3
Guam GU 2
Northern Mariana Islands MP 2

Performance of FQHCs

Figure 2 - Health Centers Perform Better on Ambulatory Care Quality Measures than Private Practice Physicians

Figure 2 – Health Centers Perform Better on Ambulatory Care Quality Measures than Private Practice Physicians

The above chart shows how health centers have outperformed private practice physicians in every aspect of service.

Figure 3 - Health Centers Provide More Preventive Services than Other Primary Care Providers

Figure 3 – Health Centers Provide More Preventive Services than Other Primary Care Providers

The above chart shows a comparison between health centers and other providers based on the number of patient visits for various ailments.

Figure 4 - Health Center Patients Are More Satisfied with the Overall Care Received Compared with Low Income Patients Nationally

Figure 4 – Health Center Patients Are More Satisfied with the Overall Care Received Compared with Low Income Patients Nationally

The above chart shows the level of satisfaction of low-income patients. Health center patients have a huge level of satisfaction as compared to other low-income patients nationally.

Financing and Reimbursements for FQHCs

FQHCs are required by law to provide services to all people, regardless of ability to pay. The uninsured are charged for services on a board-approved sliding-fee scale, which is based on a patient’s family income and size.

FQHCs are financed through a mix of Medicaid and Medicare reimbursements (with different payment methodologies), direct patient revenue, other third-party payers (private insurers), state funding, local funding, philanthropic organizations, and grant funding from the Bureau of Primary Health Care (BPHC) of HRSA of the U.S. Department of Health and Human Services (HHS).

Figure 5 - FQHC Revenues by Payer Source

Figure 5 – Financing and Reimbursements for FQHCs

The above chart shows the revenue distribution of FQHCs based on payer source.

FQHC Revenue across all regions in U.S (approx. 2018)

Location Medicaid Medicare Private Insurance Self-Pay Federal Section 330 Grants Other Grants and Contracts Other Total
United States $10,544M $1,692M $2,227M $1,004M $4,422M $2,916M $943M $23,752M
Alabama $44M $14M $13M $10M $76M $10M $2M $173M
Alaska $79M $12M $28M $9M $64M $119M $2M $316M
Arizona $257M $37M $59M $24M $78M $43M $5M $506M
Arkansas $51M $15M $18M $10M $47M $11M $1M $157M
California $2,889M $300M $205M $118M $607M $529M $272M $4,922M
Colorado $259M $30M $30M $33M $98M $88M $30M $571M
Connecticut $206M $25M $24M $8M $53M $49M $9M $376M
Delaware $10M $1M $2M $4M $12M $5M $201K $37M
District of Columbia $130M $19M $20M $3M $22M $37M $5M $239M
Florida $376M $58M $134M $59M $219M $160M $23M $1,033M
Georgia $52M $34M $39M $27M $108M $25M $6M $294M
Hawaii $87M $13M $14M $5M $26M $30M $3M $181M
Idaho $31M $15M $35M $16M $44M $24M $6M $174M
Illinois $363M $45M $116M $29M $184M $113M $44M $897M
Indiana $161M $14M $25M $14M $68M $32M $27M $343M
Iowa $63M $10M $18M $9M $40M $16M $5M $163M
Kansas $29M $9M $17M $10M $36M $14M $4M $123M
Kentucky $156M $32M $56M $17M $67M $8M $5M $344M
Louisiana $82M $14M $47M $12M $90M $32M $9M $288M
Maine $37M $32M $43M $9M $40M $8M $6M $179M
Maryland $163M $32M $45M $13M $51M $33M $29M $370M
Massachusetts $314M $91M $141M $19M $114M $246M $117M $1,044M
Michigan $268M $50M $71M $22M $119M $40M $7M $580M
Minnesota $67M $10M $14M $10M $37M $27M $3M $171M
Mississippi $33M $16M $18M $17M $72M $16M $1M $177M
Missouri $203M $21M $39M $23M $97M $39M $6M $431M
Montana $24M $8M $15M $6M $35M $10M $4M $104M
Nebraska $15M $1M $6M $7M $19M $20M $1M $72M
Nevada $23M $4M $10M $3M $18M $12M $757K $73M
New Hampshire $19M $12M $18M $4M $22M $9M $2M $89M
New Jersey $147M $11M $11M $16M $80M $60M $4M $330M
New Mexico $112M $20M $22M $18M $68M $51M $3M $298M
New York $1,099M $138M $184M $43M $243M $239M $74M $2,023M
North Carolina $69M $55M $39M $38M $120M $38M $9M $370M
North Dakota $8M $3M $7M $3M $10M $687K $1M $35M
Ohio $181M $32M $41M $15M $134M $35M $25M $465M
Oklahoma $46M $12M $18M $12M $52M $9M $2M $155M
Oregon $325M $39M $20M $12M $85M $71M $14M $570M
Pennsylvania $277M $54M $83M $17M $110M $38M $640K $588M
Rhode Island $90M $12M $15M $3M $25M $13M $2M $162M
South Carolina $79M $42M $68M $20M $79M $24M $34M $349M
South Dakota $10M $4M $8M $5M $19M $3M $2M $55M
Tennessee $66M $20M $30M $13M $78M $28M $7M $244M
Texas $335M $46M $69M $78M $245M $265M $58M $1100M
Utah $27M $9M $13M $9M $35M $25M $3M $125M
Vermont $43M $24M $26M $17M $20M $6M $7M $147M
Virginia $35M $28M $32M $20M $82M $14M $3M $217M
Washington $650M $68M $80M $44M $132M $87M $20M $1,084M
West Virginia $100M $45M $79M $24M $65M $17M $6M $338M
Wisconsin $162M $7M $24M $10M $40M $46M $3M $296M
Wyoming $1M $1M $2M $1M $7M $1M $1M $17M
American Samoa $0 $0 $0 $293K $2M $792K $0 $4M
Federated States of Micronesia $0 $0 $23K $56K $1M $143K $0 $2M
Guam $3M $8,975 $25K $139K $2M $1M $0 $7M
Marshall Islands $0 $0 $0 $29KK $527K $1M $0 $1M
Northern Mariana Islands $116K $0 $3139 $1410 $799K $0 $0 $920K
Puerto Rico $157M $22M $11M $7M $90M $8M $2M $300M
Republic of Palau $0 $0 $39K $1M $674K $50K $0 $2M
U.S. Virgin Islands $5M $776K $815K $603K $3M $4M $0 $15M

Future of FQHCs

FQHCs have had a significant growth in the past decades. The above statistical data prove that FQHCs have the potential to serve more patients thereby improving the quality of care. In order to provide quality care improve patient experience, FQHC must invest in the right technology. HealthViewX Patient Referral Management software has provided the best use cases for the major challenges faced by the FQHC.

HealthViewX Patient Referral Management Software for FQHCs

HealthViewX has completely analyzed the workflow of FQHCs. We have implemented the following features for many of our FQHC clients thus positively impacting their workflow

    • EMR/EHR integration – Our System integrates directly with electronic health records (EHRs). This enables healthcare professionals to easily obtain prior authorizations in real time at the point of care. It also eliminates time-consuming paper forms, faxes, and phone calls.
    • Insurance pre-authorization automation –  There are two ways in which HealthViewX solution automates the insurance pre-authorization process. The first one is the api-based method. Through this, we retrieve information regarding the forms and communicate information back and forth between the FQHC and the insurance company. The second one is the form automation method.  Through this, we get all payer-specific form, fill in the necessary information and send it to the insurance company via efax.
    • Intelligent Provider Match – The system has a smart search feature that enables PCPs to filter receiving providers according to their preference. The list is always up to date with the newly added specialty and imaging centers which makes it easy for the PCP.
    • To and fro Communication – At any time of the referral process, the PCP and the center can communicate with the help of the inbuilt secure messaging and voice call applications. By this, the physicians can get referral updates easily.
    • Referral Analytics – Customizable dashboards and reports provide information about the number of referrals sent, referrals in various status, referrals that were missed, processed and pending. It gives a clear picture for the FQHC and helps them in making informed decisions.

 

Reference

  1. Kaiser Commission on Medicaid and the Uninsured (data from the National Association of Community Health Centers and the Uniform Data System (UDS) of the Health Resources and Services Administration (HRSA)
  2. Goldman, LE et al. Federally Qualified Health Centers and Private Practice Performance on Ambulatory Care Measures. American Journal of Preventive Medicine. 2012. 43(2):142-149. *Fontil et al. Management of Hypertension in Primary Care Safety-Net Clinics in the United States: A Comparison of Community Health Centers and Private Physicians’ Offices. Health Services Research. April 2017. 52:2.
  3. 2015 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS. National Center for Health Statistics. NCHS Data Brief. No. 220. November 2015. Hypertension Prevalence and Control Among Adults: United States, 2011 – 2014. National Committee for Quality Assurance. Comprehensive Diabetes Care, The State of Healthcare Quality (2016).
  4. Shi L, Tsai J, Higgins PC, Lebrun La. (2009). Racial/ethnic and socioeconomic disparities in access to care and quality of care for US health center patients compared with non-health center patients. J Ambul Care Manage 32(4): 342 – 50. Shi L, Leburn L, Tsai J and Zhu J. (2010). Characteristics of Ambulatory Care Patients and Services: A Comparison of Community Health Centers and Physicians’ Offices J Health Care for Poor and Underserved 21 (4): 1169-83. Hing E, Hooker RS, Ashman JJ. (2010). Primary Health Care in Community Health Centers and Comparison with Office-Based Practice. J Community Health. 2011 Jun; 36(3): 406 – 13.
  5. Shi L, Lebrun-Harris LA, Daly CA, et al. Reducing Disparities in Access to Primary Care and Patient Satisfaction with Care: The Role of Health Centers. Journal of Health Care for the Poor and Underserved. 2013; 24(1):56-66.
  6. George Washington University analysis of the Health Resources and Services Administration’s Uniform Data System. Special Data Request, March 2018.
  7. https://www.kff.org/other/state-indicator/community-health-center-revenues-by-payer-source/?dataView=0&currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D