GE Healthcare Camden Group Insights Blog

Operationalize Population Health With a Focus on Consumer Access

Posted by Matthew Smith on Sep 16, 2016 12:53:53 PM

By Lucy Zielinski, Vice President, GE Healthcare Camden Group, and Fran Horner, Managing Partner, Singola Consulting

population_health-3.jpgHealthcare organizations are faced with the reality of value-based care. Many have formed a clinically integrated network (“CIN”) to manage patient populations while focusing on the Triple Aim (improve patient satisfaction, reduce cost of care, improve quality of care). Forming a CIN and setting a strategy is one thing, operationalizing clinically integrated activities is where the rubber meets the road. To succeed, organizations must bend the cost curve while improving quality performance and outcomes.

While in some areas, the opportunities to provide better care are obvious, other areas prove harder to improve. For example, 60 percent of referrals go unscheduled. This alarming statistic demonstrates how healthcare organizations can do better—namely by implementing operational processes that schedule referrals during the initial patient visit. Other examples include 23 percent of scheduled appointments are missed, and 36 percent of patients do not receive follow-up care. This lack of follow up and care coordination to manage patients may lead to complications resulting in increased healthcare costs, not to mention low patient satisfaction scores. Many payors, including CMS, are publicly reporting quality data and consumers are scrutinizing the scores and making decisions based on the scores. As a result, an organization may be negatively impacted from a reputational perspective, as well as a financial one.

To avoid a negative impact, organizations can focus on five strategic areas improve care, thus having an impact upon the Triple Aim.

1. Know Your Consumers

To gain market advantage, organizations must understand their consumer profile. Market segmentation enables organizations to segment consumers with similar needs and wants in an effort to match their expectations. Questions to ask include:

  • Who are your consumers?
  • What is important to them?
  • What services do they need/seek?
  • What are the socioeconomic profiles and physiographic elements?
  • Are they compliant, tech savvy, cost conscious, do they operate online, etc.?
  • How do they best receive messages?

Taking time to study your consumers is the first step.

2. Engage Patients

Patient engagement starts at registration by identifying the channels of communication—phone, email, web-portal and/or text—that the patient finds most convenient to receive appointment reminders, medical advice, and follow-up care. This is reconfirmed during discharge to streamline care coordination. Knowing how to communicate with the patient is key to truly engaging the patient in his or her care and effectively leveraging contact center technology to support outreach.

Knowing your patient population and how best to communicate with the different patient populations improves engagement. For example, if you are targeting medication adherence for your hypertensive patients, you may consider sending patient reminders for medication refills or educational material via the patient portal. You may also consider calling and reminding patients to schedule and complete routine wellness screenings such as mammograms. If patients fail to complete these screenings, then reminders can be sent via portal or text message. 

3. Focus On Outbound Communications

Outbound communications in healthcare include appointment confirmations, payment reminders, wellness updates, prescription refills, and claim status updates. A contact center can also be an efficient way to support outreach by leveraging omni-channel contact center technologies, including outbound communications, to improve care and engagement by contacting patients at the right time, with the right message, using their preferred channel of communication. Using outbound communications and technology, the contact center can play a vital role in reducing preventable readmissions. Many organizations are consolidating and centralizing contact centers to include the acute, ambulatory and post-acute environments to support care coordination.

4. Leverage Technology

As a result of the Affordable Care Act, many organizations have adopted electronic health records and reports from such systems can be leveraged to support care management. For example, using a targeted population list exported from the EHR, the contact center technology can be effectively deployed in both self-service or assisted care models. Case in point, patients who have scored 1-4 on the LACE Index may receive an automated call, voicemail, or text to reiterate their discharge instructions and remind them to call their primary care physician for a follow up appointment. Whereas patients with a score greater than 10 (indicating a high risk of readmission) would receive a phone call from the contact center nurse or care coordinator to personally follow-up on patient discharge instructions, make a follow up appointment, or coordinate referrals. Organizations, including clinically integrated networks, are focusing on the interoperability of technology to give them a leg up on patient safety, quality and cost. 

5. Optimize Change Management

Many healthcare organizations focus on technical change strategy and change management when executing tactical plans and projects. They are concerned with planning, budgeting, organizing, controlling, measuring, and problem-solving. Change management produces predictability and order in the organization. An essential but often-overlooked aspect of change strategy is change leadership—the human or cultural component that provides the spark needed to activate change. Change leadership aligns employees with a shared vision for the future of the organization, then mobilizes and motivates them to make that vision a reality. Organizations need to train their staff on how to best communicate to consumers so that consumers navigate the system with ease and satisfaction, resulting in positive surveys.

Consumers are making decision on a daily basis. Health systems, by focusing on these five strategies, can help consumers navigate their organization to make sure that the right care is delivered at the right time, at the right place and at the right price. Health systems will then be able to experience better outcomes, while attracting new patients and retain existing patients.

ZielinskiL.jpgMs. Zielinski is a vice president with GE Healthcare Camden Group. With over 25 years of experience in the healthcare industry, she specializes in helping private and hospital-owned medical groups achieve top financial and operational performance. Such optimization is achieved through physician-hospital alignment—including clinically-integrated networks, strategic planning, practice transformation, coding and revenue cycle improvement, physician compensation plan design, and health information technology, and data analytics optimization. She may be reached at Lucia.Zielinski@ge.com.


horner.jpgWith more than 20 years of experience in contact center operations and 11 of those in healthcare, Ms. Horner is a recognized industry leader who has guided numerous healthcare organizations through development of their patient engagement strategies with a focus on top-to-bottom contact center assessments, workforce optimization, outsourcing, referral management, and revenue cycle management. With extensive experience directing large-scale business operations and strategic initiatives, she is skilled at driving change and implementing cost-effective solutions while enhancing the customer experience.

Topics: Population Health, Patient Access, Lucy Zielinski, Access, Fran Horner

Access is "Critical" for Hospitals, Clinically Integrated Networks

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

Via HFMA News

Nurse, Primary Care, Retail Clinic, The Camden Group, Access, Patient Access PointsIncreasing 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, senior vice president at The 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, The Camden Group

PatientAccessBlueIt 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 The Camden Group and has 18 years of healthcare management experience. He has 15 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.” He may be reached at mmertz@thecamdengroup.com or 310-320-3990.    

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

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