As the healthcare industry shifts from a volume-based to a value-based model, care providers today must expand access to care, optimize their cost structure and adopt innovative delivery models.
Assembled over decades and under different market pressures, ambulatory networks can present major challenges for health systems as the outpatient environment struggles to meet rapidly evolving demands.
Following are three approaches even the most capable health system should consider to optimize their ambulatory networks and position their organizations for success.
1.) Assess your ambulatory network strategically and articulate your clinical and business goals
When it comes to expectations that stand to influence care delivery, a health system's strategic mandate revolves around quality, access and cost. Thus, systems should define where each ambulatory site stands compared to others in their network across these three dimensions:
A.) Quality
• Patient/Provider Experience
• Outcomes
• Variations in care
B.) Access
• Service availability
• Uptime hours
• Distance to care
C.) Cost
• Flexibility in use
• Optimized utilization
• Reduced variation
A strategic assessment can serve as a guide by comparing an existing ambulatory network against expectations and targeting how far to advance market position and role. For starters, simply viewing a network on a map instantly offers a blueprint for opportunity. Take the following map as an example -- some areas are thickets of potential duplication and geographic overlap, while other areas lack access. One reason for this is that services often represent the legacy of the site, not a modern reconsideration of how the site's services can best contribute to the overall network and system.
2.) Challenge status quo operational models
As providers, employers and payers face new expectations, health systems must consider how their ambulatory network's operational model aligns with the following reform-driven trends:
Patient Engagement. Today's patient is savvier than ever and expects a customer-centric culture. Health systems should set and promote service standards that speak to these time-constrained and well-informed buyers. Consider these tactics:
- Introduce patients to disease-specific self-management tools and remote monitoring programs;
- Offer multiple approaches to appointment scheduling, including on-line and mobile-friendly options;
- Understand micro-segmentation of community populations and designing personalized approaches to address community needs; and
- Publicize reasons for patients to visit ambulatory sites even when they're healthy by offering meeting spaces and leading educational sessions.
One-Stop Sites. Profit margins for outpatient centers are thin and getting thinner, so maximizing facility and equipment use is crucial. Leverage emerging standards for combining services, such as the Patient-Centered Medical Home (PCMH), to help re-think how to use existing ambulatory sites or develop new sites – all geared toward the population health era instead of a specialty-by-specialty rationale.
Innovative Partnerships. When planning which services to offer in a network, organizations should involve partners – both traditional care providers and new industry entrants – that can help achieve their goals. For example, a partnership between trusted fitness and therapy providers could be important in managing a total joint replacement patient under a bundled payment model, or simply influencing healthier lifestyles.
3.) Deploy facility resources carefully
More bricks and mortar isn't always better when it comes to achieving strategic goals. But if a facility investment is the right approach for a network, consider these guidelines during the planning phase:
Be Mindful of Scale. A facility that is too limited in size can hinder an organization from achieving its goals, but sites that are too broad in scope or too large in scale can be risky as well. An appropriately sized facility needs to represent the right mix of services for the market, modern operating assumptions, supportive technologies and relevant space planning metrics. Today, an ambulatory site should meet not only demands for outpatient care, but also fold in wellness services and partnerships with others in the community. Organizations need to contemplate how to incorporate these and other offerings, such as community education, retail services, complementary medicine, psycho-social support and clinical research. Performing a make-versus-buy assessment can help determine what role partners can play in providing these types of services.
Plan for Your Brand. An increasingly consumer-driven world presents opportunities to establish a distinctive brand that is exciting, transformational and clearly differentiates an organization. Sophisticated health systems are thinking ahead about how services, operations, and facilities reflect and shape their brand in the market. A facility's look and feel, operational flow and customer service are paramount in reinforcing a brand promise (or, if done poorly, undercutting it).
Labor about Location. Understanding demographics, disease prevalence, underserved markets, transit routes and travel times are vital to success. Health systems should identify which sub-market is a top priority vis-à-vis clinical and business goals and market risks, and define exactly where to build a presence. Modern geographic information system (GIS) tools that incorporate robust data sets also allow organizations to get more precise about location.
Spend Wisely. Quality and access are always essential parts of the equation, but a low-cost operating structure is also crucial to generating necessary system profitability to sustain success over the life of the facility. In the face of shrinking reimbursement, first cost is a bigger risk than ever. Organizations can maximize facility return on investment by planning the initial build of the facility for the near-term and providing master planned paths for site expansion. Build from a template or prototype that has been scrutinized by key stakeholders to minimize architectural design one-offs and long construction timelines, and evaluate cost and quality tradeoffs early for building infrastructure systems (e.g., HVAC, roofing, etc.).
Improving the health of communities requires health systems provide patients with high quality, cost effective and easily accessible care. To do so, systems of providers must align and collaborate in new and innovative ways. Strategic ambulatory network development and optimization is a catalyst for helping systems achieve their goals and make a lasting impact on the patients and communities they serve.
Phil DeBruzzi, FACHE, Director, Navigant
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