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.

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1
5 Reasons
FQHCs and CHCs Benefit from
Patient Referral Management Software
www.healthviewx.com
Learn how a patient referral software can help FQHCs and CHCs

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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
What are Federally Qualified Health
Centers (FQHCs) and what they do?
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.

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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.
What are Federally Qualified Health
Centers (FQHCs) and what they do?
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.

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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.
What are Federally Qualified Health
Centers (FQHCs) and what they do?
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.

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Their role in the front-line of healthcare makes them important entry points for patients
entering the broader healthcare system.
What are Federally Qualified Health
Centers (FQHCs) and what they do?
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.

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Improved care coordination
6
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.

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Improved care coordination
6
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.

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Better referral workflows
5
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.

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Better referral workflows
5
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.

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Chronic care management revenue optimization
4
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.

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Increased patient advocacy and access to care
3
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.

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Increased patient advocacy and access to care
3
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.

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Creating a more integrated provider network
2
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.

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Minimized out-of-pocket expenses for patients
1
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.