Enterprise hospitals are big networks with referring and receiving providers. They are finding it difficult to manage such a huge network and patient referral leakage has become the biggest problem. How can HealthViewX Patient Referral Management solution help?

1. WAYS
HealthViewX Patient Referral Management
Solution for Enterprise Hospitals
In Which HealthViewX Referral Management
Can Fix The Referral Problems Of Enterprise Hospitals
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2. Existing Patient Referral Management
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.

3. 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.
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4. Dr.James does the
insurance pre-authorization
The PCP does the insurance 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.
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5. Dr.James has difficulty
finding the right specialist
St.Luke’s 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.
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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.

6. 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.
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7. 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.
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8. 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.
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9. Challenges Faced By Enterprise Hospitals

10. Insurance Pre-
Authorization
The process of waiting for the insurance
company to respond and approve the procedures
or medication is time-consuming. If this process
is automated it would save time and efforts of
providers, insurance companies, and patients.
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11. Finding the
Right Receiving
Provider
As many of the enterprise hospitals are joint
ventures or acquisitions, the PCPs are not
completely aware of the specialists within their
network.
Many times, the PCPs refer their patients to
specialists out of their network. Finding the right
provider outside the network is the greatest
challenge as the PCP has to consider many
factors. It is time-consuming and prone to
errors when done manually.
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12. Patient Referral
Leakage
When a PCP refers the patient out-of-network, it
leads to referral leakage.
PCP can avoid Patient referral leakage if the
patient is referred within the network. When that
is difficult, patient referral leakage is inevitable.
If the patient is referred out-of-network and is not
happy with the care given, the chances of the
patient coming back to the PCP is less. Referral
leakage causes revenue loss and patient
dissatisfaction.
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13. 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.
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14. Referral Progress
Updates and
Loop Closure
When PCP refers patients out-of-network, the
chances of getting referral updates are minimal.
The specialist is usually busy and does not
update the referring provider about the referral.
Referral updates are crucial in closing referral
loops.
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15. HealthViewX Patient Referral Management
Workflow in Large Enterprise Hospitals

16. 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.
1

17. Dr.James does the
insurance pre-authorization
The PCP does the insurance authorization in the
HealthViewX application.
HealthViewX places a request with the insurance
company and coordinates with them thereafter.
The process takes place quickly and gets over in about
15 minutes Dr.James gets the consent of the insurance
company for the diagnosis.
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18. Dr.James finds the right
specialist in no time
St.Luke’s hospital had recently acquired a specialty
clinic. Dr.James is not aware of the specialists
recently added to the network.
He need not worry as the HealthViewX application is
updated with the current list of providers. With the help
of the Intelligent Smart Search feature, Sr.James found
the right specialist in his network.
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19. Dr.James sends the referral
Dr.James sends the referral to Dr.Hales via
HealthViewX application. It supports many channels
of referrals like email, website forms, type-enabled
pdf, fax, online forms, etc.
With the HealthViewX solution, sending out referrals
takes not more than five minutes.
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20. Dr.Hales schedules
appointments
After receiving the referral, Dr.Hales schedules an
appointment with the patient. Mark is notified clearly
about the appointment.
He meets the specialist on time and gets treated. This
improves his satisfaction and Mark plans to visit the
hospital in case of any illness.
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21. Referral progress updates
and loop closure
HealthViewX application supports a Timeline View
that is available to both the referring and receiving
providers.
It says all about the referral and its history. Dr.Hales is
not required to update Dr.James as it is taken care of
by the application.
Without referral updates, Dr.James can close the
referral loop without any delay. Dr.James can receive
feedback about the referral from the patient and the
specialist.
Depending on their remarks, he can improve the
process in future.
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22. marketing@healthviewx.com
+1 (214)-461-0242