GE Healthcare Camden Group Insights Blog

Access is "Critical" for Hospitals, Clinically Integrated Networks

Posted by Matthew Smith on Jun 23, 2015 3:10:25 PM

Increasing ways for patients to access care through a hospital’s clinically integrated network ("CIN") is a key to the success of new CINs, one healthcare finance advisor said Monday during a morning pre-conference session at ANI: the HFMA 2015 National Institute.

Daniel Marino, Executive Vice President at GE Healthcare Camden Group, said CINs and hospital leaders need to stop fearing non-traditional access points that patients use to enter their systems, and instead find ways to embrace them.

“Patients are accessing the system through retail clinics because it is easy, it’s convenient, and they are able to get what they need quickly,” Marino said. “Just think how those components successfully integrated into your clinically integrated network can be significant access points into your network.”

In instances when CINs identify outside providers where their patients are going to get care, he urged the CIN to establish a contractual relationship with the provider. 

Such new access points come with their own challenges, including difficulty with sharing patient information and with communication. Marino described how one hospital client approached a primary care provider to act as medical director of a retail clinic.

“That helped create some alignment,” Marino said.

But hospitals need to think about the issue of access beyond patient visits to the emergency department, primary care, or even retail clinics.

One organization used social media to set up Facebook clubs to help patients manage diabetes and different cancer services, describing the step as a social support structure.

“What they found is that by creating that, they were able to monitor the information that went out, and it created a connection to the clinically integrated network,” Marino said. “The hospital wasn’t doing this, it was the clinically integrated network.”

More CINs are focusing on access points to help keep patients in their networks. When analytics indicate the leakage rate—patients going outside the network—is more than 5 to 10 percent, the providers need to find ways to keep more patients in the network.

“At the end of the day, if they leave your network then your ability to manage costs goes down dramatically and you have very limited ability to influence,” Marino said.

Increasing access can turn into a selling point for the CIN to increase volume by touting its ability to provide convenient care. Selling the CIN to patients is particularly important in the era of high-deductible health plans, where patients actively select providers based on price and quality. 

An additional reason to focus on patient access points and leakage is because a CIN’s focus on reducing costs and improving clinical care can reduce revenue.

“If you are going to make up the difference in the revenue, the short play from the hospital CFO perspective is that you have to drive members into your organization, you have to create that value,” Marino said. “However, if you have created that value, then you can then negotiate those contracts with your payers. So access becomes critical.”

Clinical Integration Networks, CIN, Daniel J. Marino

Topics: Clinical Integration, Clinically Integrated Networks, Patient Access, Daniel J. Marino, Access

Patient Access is the New Quality

Posted by Matthew Smith on Mar 25, 2015 12:26:00 PM
By Marc Mertz, Vice President, GE Healthcare Camden Group
It is hard to have a conversation about healthcare today without mentioning quality. Government and commercial payers are putting increasingly larger portions of providers’ reimbursement at risk for performance on quality measures. Employers are seeking high quality providers to help maintain a healthy work force. Patients assume that their physicians are high quality. Public reporting sites are introducing a new level of transparency regarding physicians’ quality scores. All of this increased emphasis on quality is justified, and an organization should strive to provide and demonstrate high quality care. But if patients cannot access your services, it is all for naught.

The Importance of Patient Access

Not only does a lack of patient access impact the ability to provide quality care, but it also impacts your financial performance. In a fee-for-service environment, poor access means lower volume and lower revenue. In a fee-for-value environment groups must demonstrate high quality care and high patient satisfaction; a lack of access will impact both. Regardless of the reimbursement model, a lack of access will drive patients to find other providers. Those other providers are no longer limited to medical groups, as new providers of care are entering the market. Retail providers are rapidly expanding their number of locations and the services that they provide. These locations offer immediate access and low costs, and are often affiliated with health systems or networks. Once patients visit one of these locations they might not return to their original provider.

Getting Started

Start to address access by evaluating current wait times for appointments in existing care locations. The third next available appointment is a commonly used metric to measure access in a medical group. Best practice is within 24 hours for primary care and three days for specialty services (although some specialties like oncology are increasingly offering same or next-day appointments). Calculate the practice’s patient demand versus practice capacity and implement strategies to increase capacity as needed. If access is poor and your physicians are highly productive, then consider expanding the group by adding providers or new access points. If your access is poor and productivity is low, consider evaluating processes: Population_Health_Pyramid_of_Success1are appointment schedule templates structured correctly, are appointments the correct length, and are staff trained appropriately? Consider allowing patients to schedule their own visits through a patient portal, providing evening and weekend hours, offering e-visits, and communicating by e-mail and text. Inefficient office operations will also create waste and reduce access. Assess the work flows in the office, and redesign processes so that patient flow is efficient.

Figure 1: Pyramid of Success (left) identifies the access points that are the highest priority. Health systems and hospitals are adding hospitals, clinics, health plans, direct contracts with employers, physician practices, and ambulatory sites to their continuum of care delivery system/network. Increasing the number of access points listed at the bottom of the pyramid will help a hospital or health system reach a broader population and support the services listed higher up in the pyramid.

Medical Groups, Trends, Access, The Camden Group

mertz_headshotMr. Mertz is a vice president with GE Healthcare Camden Group with more than 20 years of healthcare management experience. He has 17 years of experience in medical group development and management, physician-hospital alignment strategies, physician practice operational improvement, practice mergers and acquisitions, medical group governance and organizational design, clinical integration, and physician compensation plan design. Mr. Mertz has managed private practices, hospital-affiliated practices, and academic physician practices. The Medical Group Management Association (“MGMA”) has identified practices under his management as “Best Performing.” 

Topics: Patient Access, Practice Management, Healthcare Quality, Marc Mertz, Access, Quality

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