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Daniel Palestrant, MD By Daniel Palestrant, MD • December 27, 2018

7 Reasons FQHCs & CHCs Benefit from Patient Referral Management Software

Founded in 2012, par8o’s technology was first adopted by hospitals and large health systems. Over the past two years, however, we have seen an acceleration of interest in patient referral systems among smaller organizations, particularly FQHCs (Federally Qualified Health Centers) and CHCs (Community Health Centers).

As I become more familiar with this part of the healthcare system, I am struck by how different the culture within these facilities is. I have found these organizations to be much more mission-driven than larger counterparts. Also of note, lacking the ability to invest in large, expensive EMRs, they are extremely scrappy, resourceful, and open to innovation - especially when it can be directly tied to care coordination, helping their populations get access to resources, or their mission.

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. In this blog, I’ll describe 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.

7. Better care coordination.

Our experience has shown that on average, one out of five patient appointments at a FQHC or CHC results in a referral. By definition, when a patient receives a referral it means there has been a change in diagnosis or an escalation in care. A well-implemented referral management system helps ensure patients get the best possible access to care and makes the patient journey from primary care to specialist as seamless as possible, even when providers are employed by different organizations or independent - which is where EMRs tend to miss the mark.

6. Better referral workflows.

Many primary care settings lack a centralized or coordinated method for managing referrals. It's common to learn that existing referral management involves the use of spreadsheets and is entirely manual. Referrals themselves are made based on individual provider’s preferences, because referring providers don't know who is in 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 from taking full advantage of the referral volume they are sending into the medical community.

5. Chronic care management revenue optimization.

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

4. Increased patient advocacy and access to care.

Patients being referred from these clinics often have limited health insurance or lack coverage at all. Finding access to specialists that accept their insurance plans (if they have insurance) and are willing to accept uninsured patients or underinsured can be a tremendous challenge, 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 maintain a set of specialist resources that referring providers know both accept patient insurance plans and provide excellent care.

3. Increased revenue from HRSA's 340B program

340B is a federal program designed to shift revenue from pharmaceutical companies to community health centers that serve uninsured and/or underinsured patients or have access challenges. Under the program, organizations receive discounted pricing on prescription drugs - the margin used to help support medical facilities which struggle based on patients' inability to pay for care.

By adding a referral management software like par8o to the referral workflow, tracking of referrals becomes much easier (more in my next section), which means retrieving consult notes from specialists is a slightly easier task. Those consult notes help 340B covered entities qualify any prescriptions written by the specialist for their patient provided the CHC is primarily responsible for the patient's care.

2. Creating a more integrated provider network.

Today, many organizations recognize their referral stream is a valuable point of leverage when advocating for patient populations. Organizations that want better customer service, quicker appointment times, and better care coordination with specialists recognize a referral management system allows them to organize, quantify, and eventually shape this 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.

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.

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