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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.



  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

How Can Large Enterprise Hospitals Overcome The Challenges In Patient Referral Workflow?

Did you know? There are about 8000+ large enterprise hospitals in U.S. Recently, Becker’s Hospital Review released the list of top 50 large health systems. How is a hospital classified as a large enterprise hospital?

Hospitals which have typically 500 or more beds are categorized as Large Enterprise Hospitals. They are capable of serving the broader needs of the community. Some larger hospitals offer a combination of acute and long-term care services while also providing research opportunities in some cases and accommodating a variety of specializations.

Considering the huge number of patients in such hospitals, the referral numbers are also high. So such large health systems face challenges such as operational inefficiency, patient dissatisfaction, care discoordination and missed referral updates in their referral process. Let us go through the patient referral workflow in detail to understand their challenges better.

Patient Referral Workflow in Large Enterprise Hospitals

In order to understand how a patient referral works in a large enterprise hospital, let us consider a scenario,

XYZ hospital is a large enterprise hospital with 10,000 plus PCPs and specialists. It is a busy hospital that sends and receives 1000 plus referrals in a day. In the workflow explained below, Mark is the patient who visits his PCP, Dr.James.

  1. Mark visits the hospital – Mark hurt his leg and was bleeding. Even after three days, the wound did not heal. He visited his PCP, Dr. James. After examining Mark, Dr.James wants him to consult a diabetologist.
  2. Dr.James does the insurance pre-authorization – The PCP does the insurance prior authorization manually. He places a request with the insurance company and waits for their response. The process takes time and forces Mark to wait. After about four hours, Dr.James gets the consent of the insurance company for the diagnosis.
  3. Dr.James has difficulty finding the right specialist – The hospital had recently acquired a specialty clinic. Dr.James is not aware of the specialists recently added to the network. So he misses the famous diabetologist within the network and looks for someone outside the network. After considering many factors like the patient’s comfort, specialist’s availability, distance from the patient’s residence, specialist’s experience etc, he finally chooses a receiving provider.
  4. Dr.James sends the referral – Dr.James finally sends the referral to Dr.Hales after trying to reach the specialist office via phone. The line seems to be engaged. He looks for many other ways which will be easy to send referrals but to his disappointment, Dr.Hales accepts only referrals through phone or website.
  5. Dr.Hales schedules appointments – After receiving the referral, Dr.Hales schedules an appointment with the patient. Mark was not notified clearly about the appointment. So he fails to show up. It results in revenue loss for the specialist and patient dissatisfaction with the PCP. Mark who is still suffering from pain and waiting for the specialist to examine him. After two missed appointments, Mark finally visits the specialist.
  6. Referral progress updates and loop closure – Throughout the referral process, Dr.James is in the dark. Dr.Hales is busy and fails to give referral updates to Dr.James. He is anxious to know if Mark was taken care of. Without referral updates, Dr.James cannot close the referral loop.

Challenges of Patient Referral Workflow in Large Enterprise Hospitals

  1. Handling multiple EMR/EHRs – Large Enterprise Hospitals and Health Systems that are formed as part of mergers and/or acquisitions tend to handle multiple EMRs. EMR interoperability is their greatest challenge.
  2. Finding the right specialist – A Large Enterprise Hospital has huge number of specialists. PCPs are not aware of specialists who were newly added or who came within their network as a result of mergers or acquisitions. So many times PCPs tend to refer their patients out of their network in spite of having the right provider within the network.
  3. Patient no-show rates – When patients miss/forget or do not show up for appointments, it results in revenue loss for the hospital. Patients miss appointments due to various reasons like no reminders, waiting time, better specialist within the locality, reputation of the receiving provider, etc.
  4. Referral leakage – Did you know? Referral leakage for any health system can average anywhere from 55-65%! Patient leakage or referral leakage occurs more in an out-of-network referral than in an in-network referral. There could be many factors such as reputation of a provider, lack of knowledge or insight and patient’s choice that lead to patient leakage.
  5. Patient dissatisfaction – Large enterprise hospitals should keep in track of the number of patients moving out of their network. An alarming 25 to 50% of referring physicians do not know whether their patients see the specialist! Patients become dissatisfied with the treatment when specialists or PCPs do not follow-up with them regularly.
  6. Referral Analytics –  As a large number of referrals flow in and out of the network, it is difficult to track the exact number. It is also tedious to track the number of referrals in various status and to close referral loops.

HealthViewX Patient Referral Management Features for Large Enterprise Hospitals

  • Multi-channel referral consolidation – The HealthViewX solution can capture fax, phone, email, online form referrals or any other referrals in a single interface. It makes it easy to monitor and manage all channels of referrals in a single queue.
  • Intelligent Provider Match – The HealthViewX “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. This saves a lot of time for the referring provider.
  • Insurance pre-authorization process HealthViewX automates the insurance pre-authorization process. The provider need not coordinate with the insurance company for prior authorization. The HealthViewX solution will do it for them. This reduces the manual effort of the referral coordinators.
  • Patient coordination framework – After finding the receiving provider, the referral coordinator refers the patient. When the receiving provider receives the referral, the provider will get notified of the referral. Even the patient will be notified of the referral. The receiving provider can schedule appointments based on the patient’s comfort. This will cut down patient no-show rates.
  • Timeline View to track referralsWith the help of a referral status, the referring provider can get to know what stage the referral is. A timeline view shows a history of stages through which the referral has progressed. The chances of a referring provider missing out on referral updates are very less.
  • Referral closure and feedback – The referring provider can close the referral when it gets completed. The receiving provider and the patient can give a feedback on the referral process to the referring provider. Thus the referring provider can make it easy for the other the next time.
  • Referral Analytics – Helps in tracking the number of referrals and gives complete information about the referrals processed, missed, scheduled etc with the help of a Referral Data-centric Dashboard.

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.






Seven Ways In Which Artificial Intelligence Is Impacting The Healthcare Industry

Artificial Intelligence or AI has accelerated the growth in various industries. The growth has been pretty quick and sometimes, totally unpredictable. So, what is AI?

AI is a combination of various technologies that imitate human intelligence. It is an essential part of the technology industry. The core concepts of AI include programming computers for certain human traits like:

  • Knowledge
  • Reasoning
  • Problem solving
  • Perception
  • Learning
  • Planning
  • Ability to manipulate and move objects

Artificial Intelligence in healthcare

Artificial Intelligence has impacted modern healthcare industry to a great extent. With the application of AI, there has been tremendous changes in the way patients are treated by doctors.

AI can be applied to both ordinate and inordinate data, with techniques including machine learning and natural language processing. Nurses and doctors are adopting technology to

  • Reduce manual work
  • Provide more accurate service
  • Give impact interventions to patients

AI helps reduce the repetitive manual work and human intervention in data analysis. A good example of this is predictive diagnosis through which medical condition possibilities can be diagnosed by monitoring the vital stats and other necessary parameters. This helps providers prepare and provide necessary proactive care as foreseen by AI systems. The predictive possibilities of AI transcends to patient experience as well. Using chatbots and AI for responses to patients reduces the burden on manual intervention for scheduling appointments, responding to common queries on the website/chatbot/sms/apps, analyzing x-ray and basic scans and much more. This can help enhance patient experience with quick response times and avoid unnecessary hospital visits.

Medication management to ensure patients are taking medicine on time and prescribing medicine according to progress is also possible with artificial intelligence and this avoids repetitive human tasks.

The promise of AI in the matters of health, including that of life and death critical issues is highly impressive.

Impacts of Artificial Intelligence in healthcare industry

The following are the top seven impacts in the healthcare industry that are most likely to happen with the advent of artificial intelligence within the next decade.

  • Reducing the burden of EHR usageEHRs are instrumental in the healthcare industry’s journey towards digitization. But the switch brought problems such as cognitive overload, endless documentation, and user burnout. EHR developers are now adopting AI for creating intuitive interfaces and automating some routine processes. Artificial intelligence may also help to process routine requests from the inbox, like medication refills and result notifications. It may also help to prioritize tasks that truly require the clinician’s attention making it easier for users to work through their to-do lists.
  • Operating mind and machine through brain-computer interfaces – AI can create direct interfaces between technology and the human mind without the need for keyboards, mice, and monitors. It is a cutting-edge area of research that has significant applications for some patients. Neurological diseases and nervous system trauma can affect abilities to speak, move, and interact meaningfully with people and their environments.  Brain-computer interfaces (BCIs) backed by AI could restore those fundamental experiences to those who feared them lost forever. Brain-computer interfaces could drastically improve quality of life for patients with ALS, strokes, or locked-in syndrome, as well as the 500,000 people worldwide who experience spinal cord injuries every year.
  • Inventing cutting-edge radiology tools – MRI machines, CT scanners, and x-rays produce radiology images that offer non-invasive visibility into the inner workings of the human body.  But many diagnostic processes still rely on physical tissue samples obtained through biopsies, which carry risks including the potential for infection. AI will enable the next generation of radiology tools that are accurate and detailed enough to replace the need for tissue samples in some cases, experts predict.
  • Improving care accessibility to underserved and developing regions – There is severe shortages of trained healthcare providers like including ultrasound technicians and radiologists. This significantly limits access to life-saving care in developing nations around the world. AI could lessen the impacts of severe deficit of qualified clinical staff by taking over some of the diagnostic duties allocated to humans.
  • Building intelligent medical devices and machines – Smart devices are taking over the consumer environment, ranging from offering real-time video from the inside of a refrigerator to cars that can detect when the driver is distracted. In the medical environment, smart devices are critical for monitoring patients in the ICU and elsewhere.  Using artificial intelligence to enhance the ability to identify deterioration, suggest that sepsis is taking hold, or sense the development of complications can significantly improve outcomes and may reduce costs related to hospital-acquired condition penalties.
  • Monitoring health through wearable and personal devices – Almost all patients now have access to devices with sensors that can collect valuable data about their health.  From smartphones with step trackers to wearable that can track a heartbeat around the clock, a growing proportion of health-related data is generated on the go. Collecting and analyzing such data and supplementing the same with patient-provided information (through apps and other home monitoring devices) can offer a unique perspective into individual and population health. Artificial intelligence will play a significant role in extracting actionable insights from this large trove of data.
  • Robotic assistance – Patients might not be comfortable with robots performing a surgery on them. How about combining the skills of a competent surgeon and the technical brilliance of a robot? That makes for a surgery with impressive levels of precision, steadiness and accuracy. And when we have AI guiding the hand of the surgeon through the help of robots, it opens the doors to extremely high levels of precision, and better patient outcomes. The AI assistant can provide patient’s past and present health details and give suggestions that would help in the diagnosis. Surgical bots use computer vision to perform surgeries after accurately calculating human body measurements. When a surgeon performs a complex surgery, AI can provide real time data that helps in identifying and reducing risk, and improving quality. Highly precise movements are made the robot hands so any tremors in the surgeon’s hands will be neutralized completely, enabling the progress and success of micro surgeries.

Benefits of Incorporating AI in Healthcare

Healthcare is definitely improving through AI. Patients and medical practitioners experience the following benefits,

  • Predictive medical carePredictive healthcare will lead to an evolving treatment model wherein the patient data is reviewed constantly to check for any anomalies, followed by suggestions of medical intervention.
  • Personalized medicationAI makes it possible for patients to have personalized care based on their body constitution and past medical history.
  • Better diagnosisFast research and cross-referencing of data leads to better diagnosis of diseases
  • Advanced treatment plans New treatment methods are generated and introduced, including robotic surgery, cell biology, stem therapy, genomics and proteomics.
  • Lower liability for hospitalContinuous monitoring of patients would ensure timely care and treatment and even reduced hospital stay.
  • Cost savings for patient and medical care provider AI can make healthcare both efficient and affordable as it helps in
    • Guiding treatment choice
    • Making more efficient diagnosis
    • Helping patients make better decisions regarding their health
    • Taking important decisions in drug development.

The healthcare industry is evolving with Artificial Intelligence. It has a great impact on the role of doctors and patients. There are some challenges like managing and integrating large data sets that need addressing, but the benefits outweigh them, and AI is here to grow and expand. AI will change every medical word – in diagnosis, in treatment, in disease detection, in treatment disciplines and more.









All You Need To Know About Insurance Prior Authorizations In Healthcare

Insurance Pre-authorization in healthcare

Prior authorization is the talk of the healthcare industry since the increase in specializations in healthcare. Any healthcare process has its own pros and cons. Prior authorization is no exception to that. A Health Insurance Company must verify if the patient is eligible for an insurance for a certain drug or procedure. Before the physician prescribes it to the patient, it is a common practice to parallely check for authorization from an insurance company. 

Current Healthcare Insurance Prior Authorization (PA)  Workflow

  1. The physician recommends a lab test – A patient visits a physician complaining of leg pain. The physician suggests the patient get an X-ray to know what is causing the pain.
  2. The lab receives the order – The lab receives the request for the test and initiates the process of prior authorization.
  3. Lab conducts PA – A separate team is dedicated for PA in most of the labs. They check the PA requirements, health plans, etc. They retrieve patient-specific data like the history of medications, diagnosis done, etc
  4. Insurance agents review Prior Authorization – Lastly, the insurance agent reviews and validates the documents sent as a part of the PA process.

The ultimate aim of PA is to optimize patient outcomes by ensuring that they receive the appropriate medication thereby reducing

  • Wastage
  • Errors
  • Unnecessary prescriptions and drug use
  • Cost

Problems presented by the process of Insurance Prior Authorization

1. Time taking process for doctorsPhysicians are dissatisfied with the time their staff has to spend interacting with health plans. When a procedure needs authorizing, it consumes a lot of admin time. It includes the time a physician spends persuading an insurance company to cover an expensive medication or a procedure. For most PA, physicians have to follow multiple steps. This involves

  • securing the correct form
  • filling it out with the required information
  • submitting the form to the plan

Physicians say that the overall process takes 30-45 minutes for each PA submission.

2. The cost involved in Prior Authorization – Though PA is the most talked about topic in the healthcare industry, little is known about its cost. In 2009, a study by Health Affairs estimated that on average, prior authorization requests consumed about 20 hours a week per medical practice

  • one hour of the doctor’s time
  • six hours of clerical time
  • 13 hours of nurses’ time

It further revealed that when the time is converted to dollars, practices spent an average of $68,274 per physician per year interacting with health plans. This equates to $23 billion and $31 billion annually! Prior authorization ultimately ends up costing the health care system more than it saves.

3. Patient delayThe real impact of PA is often felt by patients whose treatment is delayed. Nearly all physicians noted that wait times increased the delays in necessary care, which added to the risk of adverse events. According to AMA, a PA decision takes at least one business day for 64% of physicians and 3 or more business days for the rest. During this time, patients are unable to start treatment. These long wait times have a negative impact on patient experience and patient care.

4. Management of Prior AuthorizationThe management of PA can sometimes be difficult to manage. This is because the requirements can vary widely from one insurer to another. Each one has a different process for submitting prior authorization requests. The process cannot be standardized at times and must be done manually. This will of drain resources and time if this is already limited.

How can the Insurance Prior Authorization process be improved?

Healthcare Insurance Prior Authorization is a necessary step in many practices. But the current process is all too often manual and involves a cumbersome workflow. It may result in delays in treatment and dissatisfaction for patients and medical practitioners. As a result, many are implementing electronic prior authorization solutions to address common issues with the approvals process.

HealthViewX Referral Management solution makes the referral workflow easy for the practices. It has the following features that make the process of Prior Authorization simpler.

  1. EMR/EHR integrationOur 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.
  2. Timeline View – Both the center and the PCP can view the timeline data of the patient in which the referral history is present. Documents and notes can be attached anytime for one another’s reference.
  3. 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.
  4. Referral Data Consolidation – It has options for printing the consolidated data about the referrals and the referral history of any patient as a hard copy at any time in pdf/excel.
  5. Secure Data Management – HealthViewX Patient Referral Management is HIPAA compliant. It manages all patient-related documents securely.
  6. Referral Analytics – Helps in tracking the number of referrals and gives complete information about the referrals processed, missed, scheduled etc with the help of a Referral Data-centric Dashboard.

HealthViewX Patient Referral Management solution helps practices in managing their prior authorization process and saves their time and money. Are you a practice looking to ease your prior authorization process? To know about HealthViewX Patient Referral Management System in detail schedule a demo with our team.

HealthViewX Version 2 Is The Solution To The Challenges Faced By The Healthcare Industry

HealthViewX is excited to announce the launch of its all new version. HealthViewX 2.0 is advanced version of our healthcare product that has been,

  • Designed to suit any practice
  • Customized to meet the user requirements

What is HealthViewX?

HealthViewX is a care orchestration platform passionate about building a user-centric healthcare ecosystem. We aim at,

  • Improving patient and provider experience
  • Creating defined workflows
  • Raising the standard of care

We are at the forefront of enabling a collaborative platform for better care coordination & efficiency of care to enhance provider-patient relationship.

How does HealthViewX help?

The HealthViewX end-to-end Care Orchestration Platform guides healthcare organizations through its entire care journey by enabling data-driven decision support and providing real-time insights of patient reported data to promote better care delivery. The platform enables secure communication of patient information and remote monitoring of patient vitals to improve participation and create an interoperable ecosystem for care delivery. We provide three major solutions, they are,

What is exciting about HealthViewX 2.0 ?

In this period, healthcare industry is experiencing its most drastic changes in terms of technology. Every healthcare provider wants to give the best possible care to the patients in their network. So HealthViewX, a care-orchestration technology platform is focused on providing end-to-end healthcare lifecycle management. With enhanced technology, HealthViewX helps healthcare providers in,

  • adapting and evolving to meet the changing needs of the industry
  • providing the best quality care for its patients

Though HealthViewX has the right solutions for the pain points of the healthcare industry, customization was needed for each client. Through many discussions with our clients, we figured out that though many practices have similar challenges, each one had a unique workflow. Everytime we onboarded a new client, we had to modify the workflow to suit their needs. This was time-consuming and difficult. For eg: HealthViewX has a Chronic Care Management solution. One of our clients wanted to track all call logs within different ranges. Another one of our clients wanted to track only call logs with more than 60 minutes duration. This configuration was not easy as the components were static and not reusable.

This is when HealthViewX product experts wanted to make the product more reusable and dynamic. We realized that every practice had unique requirements and workflow. So we enhanced the product by making it a component-based with drag and drop workflow creation in minutes, simple user interface and real time plug & play usable components.

HealthViewX 2.0 features

HealthViewX solution has the following unique features,

  • Report and Analytical Engine – This helps the users in customizing the information they see on their dashboard and also the information they want to download as reports. Customizations mean the users can choose the format and what data or information they want to view. This information will be a great analytical tool for practices who can study such information and make changes accordingly in future to generate more revenue.
  • Module Engine – The users can now create and manage new modules (e.g. CCM, Billing module etc). Previously with version 1, module creation required more effort and time. Version 2 has made module engine so simple that it can be created by the users themselves.
  • UI Studio – The users can define the design and the layout of data on various modules and forms. This customization allows them to view the data in the way they want to.
  • Template & Form creation – This helps in creating and managing various forms in the platform (e.g. Prior-authorization form, Patient referral letter). For eg: In a prior authorization form, the user can design it with the information they need instead of using a standard form.
  • Integration Engine – This engine now enables setting up link between other systems (EHR, schedulers). The users can manage information on such systems easily with the help of this integration engine. Also it manages back and forth communication.
  • Communication component – It enables asynchronous Messaging, Fax, SMS, and Email. It enables the users to stay in touch always so that they don’t miss out on sensitive information.
  • Custom Workflows – The users can now create and update custom workflows that suit their practice.

HealthViewX solution is customizable and user-friendly. The above features are promising and solves most of the challenges in the healthcare industry. To know more about our solution, schedule a demo with us.

Streamline Your Patient Referral Workflow With HealthViewX Patient Referral Management Solution

Most healthcare providers are aware that referrals are critical, high-quality, and high-value demand generation channel. Did you know?

  • More than one-third of all patients seen are referred
  • Additionally, over 46% of faxed referrals never result in a patient visit
  • An estimated 50% of referring physicians never know if their patient was actually seen

But there are some mistakes every provider makes which can affect the revenue and the referral process to a great extent.

Common mistakes in healthcare referral programs

1. User Interface Design – Referral programs should be so simple to use that the physicians refer their patients without facing any issue. There are many constraints physicians face while initiating referrals. Some constraints include,

  • Sending referrals to receiving providers in the preferred channel
  • Poor website structure with little information about referrals
  • Handling paper-based forms of various templates for sending referrals 

These confusions cause a bitter experience to the referring physicians. The chances of PCPs referring to such specialists are less.  This will lead to the failure of the referral program.

2. Complicated referral process – A referral program should not impede the existing workflow. It should not require extensive hours for a person or group to manage the referral program. One of the major problems faced by referring physicians is that they have to manage multiple systems or software for initiating a referral. For eg: A referral coordinator must take the patient information from the EMR/EHR and then create a referral through fax, website or direct message. This complicates the process for the referring physicians.

3. Finding the right specialist/imaging center – The number of imaging centers and specialist practices is increasing day-by-day. The referring physician does not have the list of all such imaging centers and specialty practices. The chances of missing out on a good receiving provider are high. With a manual process in place, it takes a lot of time and effort for the referral coordinator to narrow down the referral coordinator’s search and find the right one.

4. Time- consuming referral process – As the referrals are handled manually, a referring coordinator spends about half-an-hour to one-hour for a creating referral on an average and even more time in following up the same.

5. No system to give referral updates –  After a referral is sent, both the referring and the receiving providers so not have easy access to updates. The referring and the receiving providers lose track of the referrals as it is difficult to coordinate manually for such referral updates. This results in open referral loops.

Monitor your patient referrals better with the HealthViewX solution

Referring physicians can address the referral workflow challenges and achieve a streamlined referral pipeline with the help of a software solution. HealthViewX Patient Referral Management solution enables creating a referral in three simple steps thus providing a successful referral program. After the referral is created, it can be tracked with help of the status. Both the referring and receiving providers will be notified of the appointments, test results, treatment recommendations, etc. HealthViewX can integrate with EMR/EHR and can also coordinate between the referring and the receiving sides. Any referral has a timeline view which is common to both the receiving and the referring providers. In the timeline view, history of the referral can be seen for eg: notes related to the patient’s health, previous status of the referral, etc. Documents attachment and status change can also be done at any time of the referral process. HealthViewX Patient Referral Management solution can always keep you updated on the progress of the referral thus simplifying the referral process and helps in closing the referral loop.

HealthViewX Patient Referral Management solution helps the referring provider to track the referral progress. Schedule a demo with us and our patient referral management experts will guide you through our HIPAA compliant solution.

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
  • their 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 refer now 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.