Health systems are facing an escalating emergency department (ED) boarding crisis, driven in large part by the surge in behavioral health patients seeking care. Since COVID-19 pandemic, demand has intensified while capacity and coordination have struggled to keep pace.
As a result, EDs are increasingly becoming holding areas—not treatment environments—for patients awaiting appropriate behavioral health placement. This creates strain across the system: longer wait times, reduced ED throughput, clinician burnout, and compromised patient outcomes.
Despite the urgency, many organizations still rely on fragmented, manual, and outdated processes for intake, transfer, and referral—phone calls, faxes, and disconnected systems that slow decision-making at the exact moment speed matters most.
AI-powered solutions are beginning to change that.
Improving behavioral health referral coordination was discussed at Becker’s 2026 Behavioral Health Conference, during a session sponsored by XFERALL and moderated by Amanda Brown, senior vice president for growth at XFERALL, featuring:
● Jaya Agrawal, Divisional Executive Director, patient placement center – South, Providence (California)
● Shana Palmieri, co-founder and chief clinical officer, XFERALL
● Chris Vernaci, assistant vice president, technology ventures, Universal Health Services
Here are three key takeaways from the session:
1. Traditional intake, transfer and referral processes have been a barrier to transfers
These processes have been slow, manual and paper-based, and have distracted staff. “Sometimes the staff doing intake is a nurse,” Mr. Vernaci said. “Intaking a patient means pulling her off the floor to review a 200-page fax.”
At UHS, 60% of referrals come through fax and the rest from phone calls and referral networks, requiring staff to respond to requests from multiple platforms. This siloed approach lacks transparency and results in delays that can be harmful for behavioral health patients, who often get more distressed while awaiting placement.
“We hear a lot about access to care being due to a lack of beds,” Ms. Palmieri said. “It really is a system-level operational issue.”
2. XFERALL helps health systems consolidate multiple intake modalities into a single platform
This solves the problem of not having enough staff to do intake and burdening front-line caregivers or non-clinical staff with that responsibility.
XFERALL’s consolidation capability supported Providence’s decision to centralize behavioral health transfers. Standardizing that process enables XFERALL’s AiXcel™ AI quickly parses referral data for faster and this capability also ensures 24/7 intake on weekends and after hours can be the most efficient with existing staff. XFERALL’s s AiXcel™ also accurately summarizes each patient’s medical and behavioral health information, better informing key stakeholders about a patient’s situation and expediting the review of clinical information so clinicians can make a decision more informed and faster.
“We love XFERALL — it has improved our placement time and reduced our ED length of stay, made employees’ jobs easier and increased employee satisfaction,” Ms. Agrawal said.
3. Transparency is critical for successful placement of behavioral health patients
Analog approaches to sharing information, such as fax and phone calls, do not provide visibility or transparency. XFERALL’s referral processing and placement are transparent, so providers can easily see where that patient has been placed. “Having a technology with multiple layers of transparency and visibility on a patient’s journey is critical to make sure they are going to that next level of care,” Ms. Palmieri observed.
Sharing accurate, concise information via XFERALL with potential placement sites enables these sites to make faster decisions about accepting patients and to respond faster.
“To my surprise, within a few minutes people respond and say they are interested — sometimes within 10 minutes they will accept,” Ms. Agrawal said. “It’s so fast. It used to be days before someone showed interest or accepted. This has changed the speed and the market.”
At the Becker's Fall Behavioral Health Summit, taking place November 4–5 in Chicago, behavioral health leaders and executives will explore strategies for expanding access to care, integrating services, addressing workforce challenges and leveraging innovation to improve outcomes across the behavioral health continuum. Apply for complimentary registration now.
