Beyond the Appointment Slot: Transforming Patient Access

LISTEN TO THE EPISODE:

 

Daniel Marino:

Welcome to Value-Based Care Insights. I am your host, Daniel Marino. In today's episode, we are going to dive into an issue that I think every health system across the country is struggling with, and that is managing patient access. Access has really evolved over the last number of years. And when you think about access, it's really more about filling physician or provider schedules. It's really around accommodating the needs of our patients and really the changing needs of our patients. And as we think about it over the last number of years, really since COVID, the needs of the patients, what patients desire in terms of their interaction with their physician certainly has evolved. Technology has helped that, right? So many of us enjoy having technology, creating the efficiencies of using our phones, scheduling through our phones, oftentimes not even talking to a real person, but just doing it through the technology and help to support a greater interaction with not only maybe our physicians, but really with anything even outside of the healthcare industry. But it's also created a lot of challenges for healthcare organizations. No secret, healthcare is slow to move to a lot of the technology and the innovations as compared to other industries. And some of the challenges that we're seeing in access certainly are as a result of that. But having strong access processes, having a model around access is such an important driver of growth of the patient experience, as well as the physician and the provider experience.

Well, I'm really excited to dive into this topic today, and I have two wonderful guests that are joining me. Jon Fullerton is a senior healthcare operations leader with a large healthcare system. He has more than two decades of experience and strategy, process improvement, patient access, and ambulatory care. I'm also joined by Jenny Hart. Jenny Hart is a healthcare administrative leader, consultant working with ECG. She has more than 20 years of patient access experience and ambulatory operations. Jon, Jenny, welcome to the program.

 

Jon Fullerton:

Thank you, Dan. Very, very excited to be here.

 

Jenny Hart:

Thanks.

 

Dan Marino:

So, Jon, maybe we could start with you. You know, from your experience, talk a little bit about what you see are the current challenges right now that organizations are struggling with as we think about patient access.

 

Jon Fullerton:

Sure. I'd say one of the biggest challenges that I see is really the patient demand is continuing to outpace capacity in many areas. But as you were mentioning in your opening, it's also while patient expectations are very rapidly changing. Patients are increasingly expecting convenient digital access. They want timely communication. They want transparency. They want the ability to complete more tasks themselves. At the same time, we have to make sure that patients are also reaching the right care at the right time. So oftentimes we talk about access if it's simply the number of available appointments, but it's much more complex than that. And a patient may get an appointment quickly, but if it's with the wrong specialty, the wrong clinician, the wrong visit type, we really haven't solved that problem. So, and that also creates a lot of rework for clinicians and staff downstream. So I'd say the opportunity that I see is really to improve how patients are being directed while making better use of the clinical capacity that our clinical leaders already have.

 

Dan Marino:

So, Jenny, a lot of organizations, a lot of physicians this day and age, extremely busy, right? I mean, they have very little capacity in their schedule. Most of the time, their schedules are extremely booked and they're booked for many weeks out. So when we think about access and with the goal of maybe opening up capacity, how are organizations thinking about that change? How are they thinking about either, you know, opening capacity, changing the types of visits, all of that to accommodate what needs to happen both with the patients and with the physicians, if you will.

 

Jenny Hart:

That's a great question. I think the number one problem that we have in our systems today is that we believe that providers fundamentally could work harder than they're already working today. And it has to be traded out somehow. So when we think about all of the activities we're asking our providers to do today that include some dinosaur practices like manually transcribing their notes, like preparing record review for patients, all of these activities that are not really using them at top of license. And then you add to that the human element of the people that they're interacting with. So even though we've come a long way with value-based care and trying to incentivize people based on results, most of this country is still on this productivity-based model. And so if we can't think about how we can actually get them to be productive, understanding that patients can interfere with that productivity through late cancellations or not showing up for their appointments, It's really thinking about how we can better design our system, our technology, and then the workflows that we're using to offload some of that work from providers and identify all of the opportunities we have to be more efficient with the provider's time. So it's not about necessarily working more, it's about working differently.

 

Dan Marino:

Absolutely. And I can't help but think, you know, as we think about process improvement, you know, what you've just described, it really comes down to people, process, and technology. So John, let me turn that back to you. You know, many organizations are either on Epic or they're on Cerner or they're using an EHR that has some level of a patient portal, right? Where does that technology piece come into play? You know, and does that really go against some of the patient access goals? In other words, are patients truly leveraging their portal and the connectivity around that portal with the physician like they should? Or is that a huge opportunity to really be into better manage some of the access challenges.

 

 

Jon Fullerton:

I personally believe it's a huge opportunity. I think we're at a place where the technology is there, the patients have the expectations, and to have that capability when it comes to healthcare, because they're using very similar technology in a number of different other industries, but I think we're kind of dropping the ball still is just meeting in the middle. I think whether you're looking at online scheduling, mobile communication, waitlist automation, you know, anything like that, a lot of that will give us, as a healthcare system, better decision support, better analytics, we're going to have a lot more information and it's going to make it more convenient for the patients and we'll have more responsive patients. I think also too, the more that we can leverage that, it will really help us when it comes to forecasting demand, you know, unused capacity, things along those lines. I often talk with leaders that I'll work with about where we may think we're utilizing, you know, all of the features that are available to us in Epic and we're really not scraping the surface. And so future state technology, it has to be continued to be a priority as we're doing this work. But I think importantly, too, as we're going through it, is making sure that the focus of that we're improving both sides of the experience, you know, both obviously the patient experience, but how can this also, you know, shift some burden, you know, from that may be on the clinicians or the staff currently?

 

Dan Marino

Sure. So, Jenny, when you when you've worked with organizations across the country, do you feel like the technology is really underutilized?

 

Jenny Hart

Of course, right? Like we wouldn't exist as administrators if everything was going well. I think the hardest part about that though is that we talk about technology as if it is the silver bullet. That silver bullet has to be intentionally crafted based on the service line needs, the individual workflows of the hospital, etc. So it's not just a...If we get on the magic EHR, everything will go away and get better. Jon, I was actually thinking about what you were saying about how we want the patient experience and the provider experience to improve with technology. But if each service line in a hospital is behaving differently, the best technology in the world isn't going to give that patient the same experience. So if a patient has referrals to five different service lines, and they have to interact with those service lines five different ways, they're never going to get good at it, even if we're offering online services or even if we're offering transparent pricing, because it's going to look and feel different every time. So I think not ever understating the need for teams to work together as a team to create that system.

 

Dan Marino:

Yeah. So as you're talking and you're thinking, you know, as both of you mentioned the patient experience and then the physician experience, when we're working through access and putting in place new solutions, do you think those two goals can be aligned or do they conflict? And I guess what I'm thinking through is I worked with an organization a couple of years ago who was adamant about putting in a centralized scheduling system. And when they put that centralized scheduling system in, they did it with the goal that internally they wanted to reduce cost and help to be able to provide a better experience for the physician, and hopefully for the staff. But they did it in such a way where it actually created more challenges for the patient. And what they found was the way they approached that with centralized scheduling helped them internally because it did reduce costs, but it actually came in a cost to the patient because the patients were unbelievably unhappy. So when we think about patient access, how do you drive the objectives of the patient and that patient experience with the goal of expanding or enhancing the physician experience?

 

Jenny Hart:

I think John, you should take us to church on this one, because I think you've got strong opinions.

 

Jon Fullerton:

Yeah, yeah. I think kind of that example you're talking about where, you know, sometimes the goal and the focus, it may feel right, but I think it all goes back to kind of like starting from the beginning where, you know, if you're looking to address some challenges when it comes to access, whether you're a single location, a health system. I really think it's most important to start by looking at the patient journey combined with the clinician and staff experience. That can sometimes be time consuming, but it's incredibly important and crucial to really understanding what do we want to focus on improving, you know, you can pick a common condition, you could pick different referral types, various specialties, but really follow through what is happening from the moment that a need is identified for a patient until the time that they receive care. And I think that can be a bit eye-opening, but it can also more importantly help you shift your focus and really identify what two to three goals do we really want to accomplish. I've seen situations where when you have 10 to 20 different areas of focus or goals you want to achieve when it comes to access work, oftentimes most, if not all, just won't happen. It becomes difficult to govern a number of different things. So really identify where's the patient waiting? You know, when is information getting lost? Where does a care team have to rework something? I think that is what usually helps reveal, you know, a manageable number of opportunities that then leaders can look at and say, where can we get our best ROI? Where can we improve our team's experience and ultimately improve patient experience.

 

Dan Marino:

And I love that as a suggestion. So to really process flow out that patient experience and really the whole scheduling process, right, to see if there are those barriers. And then as you're talking through that, that's going to help you identify challenges within either the clinical staff, or the physician's workflow that may be creating barriers. Maybe out of that is, you know, that's how you then really begin to align those two experience factors from patients and from the physicians.

 

Jon Fullerton:

Yeah, absolutely.

 

Jenny Hart:

Also, I'll also add that the patient workflow is not linear. And so oftentimes the patient is looking for us for multiple reasons, like again, multiple specialties. And one of the things that technology is quite good at now that didn't exist even, let's say, 10 years ago, is the ability to look at a patient's journey across telephony systems, across different technology outreach attempts, so that now contact centers, when they pick up the phone, can understand that Jenny called at 5 AM, she called at 8 AM, she called at 10 AM, she called at 10 30, and now she's real mad and it's 1 o'clock in the afternoon. Her need still hasn't been resolved. And the contact center at that point can say, oh, hey, I see that you have had this journey already. I see that you need not only this, but that, and I can help you with all of these things.

 

Dan Marino:

Yeah, so it's really using that technology piece as well as then the workflow to really understand how you can identify some of these challenges and these barriers. And then to, you know, to enhance it right through a process improvement exercise. If you're just tuning in, I'm Daniel Marino, you're listening to Value-Based Care Insights. We're having a fascinating discussion around patient access. And I'm here today with John Fullerton and Jenny Hart diving into a lot of the elements of patient access. I want to turn the discussion a little bit to some of the culture transformation that undoubtedly is part of access, right? You know, and as I've worked with physicians over the years, physicians get set in their ways. They have their own practice styles. There's things that they certainly enjoy doing within their practice. And frankly, that's how they organize and manage their day. So when you go into Access and there's the potential of changing either the physician templates or maybe, you know, changing some of the activities that they're saying, even, you know, how the time increments of their visits, you know, we're sort of, quote un quote, moving their cheese, right? How have you managed through some of that culture transformation with the physicians? And Jon, maybe we could start with you. When you've had these discussions with the physicians, how have you gotten them on board? Because I can't help but think that this creates a tremendous amount of anxiety for physicians as we're thinking about all of these changes that essentially we want to put in place.

 

Jon Fullerton:

Yeah, no, absolutely. One of the things I'd say is start engaging with them early. I think one of the huge things anytime you're, regardless of what you're doing to address access, is you want to make sure your clinicians don't feel like this is being done to them, but they're doing this with you. I think another huge piece is access. It has to become part of an organization's clinical mission rather than just be a separate operational project. Clinicians and staff, they need to be able to see how the work is improving continuity, how it is reducing delays, whether it's in diagnosis or treatment, and how it's removing friction from their daily practices. The leaders, it's really important also to just make sure that the need is there to demonstrate that workforce experience is a design requirement. That is just not an afterthought. And I think when you keep that as a focus, over time, you'll see those culture changes really happen when your people are seeing both the patient benefit, but also the practical benefit as well.

 

Dan Marino:

So, in driving that, Jenny, around a lot of what John had said, you know, kind of working through that transformation, how important is it for organizations to take a focused approach around maybe an operating model, right? Something that is tangible. Are you seeing organizations shift to creating maybe a separate, I don't know, office or separate division, separate structure that just looks at patient access? Or does this still embedded as kind of a project or an element of ambulatory care services? Where does it fit in as we start to think about that transformational change?

 

Jenny Hart:

So best in class access organizations across the country have access governance. It is a continuous body. It is a mix of physician and administrators across multiple service lines to make sure there is representatives. We make sure that there's clinical representation not only with physicians, but also with the advanced practice providers, it is critical. I think whenever we start access transformation work, it has to come from that, what are the shared rules of the road and how do we follow them together? And the piece that's usually missing for me before that even happens is an alignment of what we're actually trying to achieve. And so when we think about access transformation, usually systems fail in the past by trying to eke out small changes that create this kind of Frankenstein environment of we've just kind of patched this problem and patched this problem and nothing fundamentally changes because we're all trying to operate under this fear that we're going to tick off somebody and then they're going to quit. And what I found is that I'm actually kind of in love with this quote right now. It's from Kung Fu Panda. But Master Oogway says, one often meets his destiny on the road he takes to avoid it. And I see that so much in the templates that we have. It's so good, right? It's a cartoon. Amazing. But anyway, the thing that I see in templates is that we have these templates that are horrifically constructed out of fear. Like a horrible thing happened to me where the wrong kind of patients showed up. And so I'm going to construct my template and just so that fear and that pain never happens again. And what we're suggesting.

 

Dan Marino:

Yeah, right. So it's fear driven more than anything as opposed to, you know, vision focused.

 

Jenny Hart:

Absolutely. Absolutely, absolutely. And then another thing that you see is that they kind of shut down in this protection mode, and that protection mode isolates them from the system's larger ability to serve them. And then they say, the system isn't helping me. And so what governance does, set up correctly, is provides those guardrails to say, you know what, every single one of us are accountable to the same mission. We are no longer defending status quo. We are defending why status quo should change, else we're changing, because we have to do this or we will die as a system, not as individuals, but as a system.

 

Dan Marino:

Yeah, and that's such a great point, because I think when you see those inefficiencies, it just sort of builds on itself. And then that's where I think a lot of the frustration comes into play. So Jon, let's talk a little bit about measurement, right? What are some of the key performance indicators that you see that are important to help drive some of those changes? And, you know, those changes are hard because, you know, you sort of, to Jenny's point, you get into this position where you're constantly looking at all of the challenges and then the blame game comes into play. So what are the things that you've started to look at from a performance indicator perspective that has helped to support the culture transformation or some of that change?

 

Jon Fullerton:

No, absolutely. Great question. I think when we look at traditional access measures, when you're looking, whether it's third next available, appointment lead time, fill rates, no-shows, those remain very important and should continue to be tracked. Because of where healthcare is going and we want to evolve to, I think it's also important to be tracking digital adoption, self-scheduling completion, waitlist offer acceptance, how often are technologies successfully helping a patient really to obtain an earlier appointment. Those don't always tell the whole story. You know, also really emphasize the importance around looking into referral turnaround time, appointment appropriateness, incomplete referrals, you know, schedule utilization, anything that might be avoidable rework as well, or things that could be inbox or message burden on the clinician and staff. When doing this as well, really incorporate clinician and staff feedback.

 

Dan Marino:

Absolutely, yes. Well, and I think to Jenny's point, that's where the physician governance really comes into play, right? I mean, that needs to be such an intricate part of what we want to begin to do and also ensuring that we're looking at the right things to measure the performance as we move forward.

 

Jon Fullerton:

Yep, completely agree. It's crucial, but it also has to be meaningful too.

 

Dan Marino:

Yeah, absolutely. So for any of our listeners that are tuning in, as I mentioned early on, I think every organization is struggling with access, right? And Jenny, maybe we can start with you. For any of our listeners, if you were to give them one or two pieces of advice as to maybe where they start, or where they need to think about making that transformational change for access, what would that be? What would come to mind?

 

Jenny Hart:

I think the first thing to me is always, do we have a shared language around the goal? What are we actually trying to achieve? Does everybody know what we're trying to achieve? Does everyone know what's expected of them? And does everyone have the tools to be able to, in an autonomous way, go after that goal? So I think that's number one is how are we defining success? The second is what are the tools we already have today that we're not using to their fullest? So let's not think about the brand new $3 million solution. Sorry to the AI vendors out here who are desperately trying to peddle it, but we have all of this stuff in-house, how do we make best use of that and then see what our next problem is so that we're only adding to our solutions when we know what that actual problem is.

 

Dan Marino:

Yeah, that's great. And John, how about with you? I mean, you're living in this world day in and day out. Any advice?

 

Jon Fullerton:

Yeah, yeah. I touched upon it earlier with, I think, starting with examining the patient journey and also the clinician and staff experience and their journey is important. I think also too, for an organization, if they're kind of thinking of where do we start with this, paired with that, bring a small group of clinicians, staff, scheduling partners, bring them together, make sure it's thoughtful and they're coming from different areas of the ambulatory setting and just review some of these journeys, what your findings are, have them, you know, ask whether each patient reached the right clinician, really have a focus group like that. Start examining what's going on today across the ambulatory. While it may not be happening in their clinics, it could be happening in others. And again, we want our patients to, if you're a health system or a single hospital, you want your patient to feel like they're a patient of that organization, that system, that hospital, not just necessarily that specific clinic or department because they may be getting seen in multiple areas. I think that's when you can really ask where the process is creating that unnecessary work and it helps you start shifting your focus as to where the biggest areas of opportunity could be.

 

Dan Marino:

Yeah, really creating that connectivity and stickiness with the system as well as then with the physician. And I think that gets back to Jenny's point where, you know, the vision of success has to be clearly defined.

 

Well, I want to thank you both for coming on the program. This has been a great conversation. I feel like we just barely scratched the surface. A lot, lot here. And, but I really want to thank you for a lot of the insights that you've given today. And, you know, I'm sure a lot of our listeners, you know, may have additional questions and may want to reach out, you know, at some point. And we'll be sure to kind of funnel a lot of those questions to both of you. But I really want to thank you both for coming on. Thank you.

 

And I want to thank our listeners for tuning in. If you're interested in learning a little bit more about this topic or any of the topics that we speak about here on Value-Based Care Insights, please log into Luminahp.com/insights or ECGMC.com for more information about this topic or many others. Again, thank you all for tuning in. Until our next insight, I am Daniel Marino, bringing you 30 minutes of value to your day. Take care.

About Value-Based Care Insights Podcast

Value-Based Care Insights is a podcast that explores how to optimize the performance of programs to meet the demands of an increasingly value-based care payment environment. Hosted by Daniel J. Marino, the VBCI podcast highlights recognized experts in the field and within Lumina Health Partners