Healthcare Analytics, Population Health Management, Healthcare Big Data

Quality & Governance News

Patient Management, Attribution Program Expands Access to Care

By Jennifer Bresnick

- While hospitals and health systems face numerous obstacles when it comes to caring for patients across a complex, convoluted continuum of care, sometimes the most challenging part of the process is ensuring that patients are able to make initial appointments with the right healthcare provider in the first place. 

Kim Nicholson discusses patient management and access to care

The process of ensuring long-term patient engagement and retention often starts with a phone call from a potential consumer wondering if a healthcare system’s services are right for their needs.

Providers must start off that conversation on the right foot if they want to snag a consumer’s loyalty – not to mention their potential for generating revenue.  In an era of accountable care, where patient attribution and the delivery of comprehensive in-network services are directly related to reimbursement, a robust patient management and retention process is a foundational element of population health management and value-based care.

Healthcare organizations must understand the patient management process, and have the data and analytics capabilities to back up their efforts, if they want to help their consumer base access the right physicians quickly and effectively. 

As Vice President of Access and Service Lines at Swedish Medical Center in Washington State, Kim Nicholson saw an opportunity to take control of patient management for the multi-site system and nearly double the conversion rate of initial calls-to-appointments.

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We were seeing that some patients were having challenges getting into our health system,” said Nicholson, who is now Chief Operating Officer of Clinical Program Services at Providence Health & Services.  “We were outsourcing our patient access programs to another vendor, and not getting the results we had really hoped to receive.  So about two years ago, we began to look at alternatives in terms of insourcing the access center, and we launched the program in June of last year with Kyruus as our partner.”

“When we outsourced our patient management, we were looking at a baseline of about 28 percent of calls converted to appointments,” she explained.  “Within three months of launching the program, we were at 70 percent of calls to actual booked appointments. We're staying steady around that 65 to 75 percent conversion rate.”

The results are due to two major changes: a heightened focus on the health system’s data integrity and the application of local knowledge to the patient intake process.

“When we were outsourcing this, we found that the data with which our care coordinators or access employees were making decisions was not really customized to our organization,” Nicholson said.  “Basically, it was a direct data feed from the medical staff database, and it wasn't current or up-to-date.”

“As we began to look at insourcing, we realized the importance of keeping this data accurate and making sure it was really a single source of truth for the entire system.  So there was a lot more emphasis being placed on the information that was going into it, and also making sure that it was easy to identify and easy to access.”

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Up-to-date information is only as good as the people interpreting it, and insourcing the patient management project allowed local staff to overcome some of the inherent problems that arise when call center staff are not familiar with the nuances of an individual community.

“The outsourcing vendor had a pretty apparent lack of knowledge about our current marketplace,” Nicholson admitted.  “Any time a customer call center is outsourced, I think it's hard for those associates to know the marketplace that that particular caller is calling in from.”

“So we would listen in on calls, and folks would say, ‘I want a primary care physician at the Ballard campus,’ and I would listen to the call as the vendor would say, ‘Well, gosh, we can't find any primary care physician for you.’ Then caller states, ‘Well, I'm actually standing outside of your hospital and I see that you have primary care here.’  This is after they've spent five to ten minutes giving all their information.  It resulted in a lot of frustrated consumers trying to access our services.”

Taking charge of the patient management process hasn’t just helped patients make their first appointments.  It has also made sure that patients are seeing the right physicians for their needs, both clinical and financial.  As health systems expand their value-based reimbursement contracting and form accountable care organizations, making sure that patients are staying with the frameworks of these new reimbursement structures is important for all parties involved.

“Within our system, we can actually see who is covered by which plan, and so that really helps us guide our searches very easily.  It's been very intuitive, even when we have these complex ACO-type products,” explained Nicholson.  “We’ve been able to access that right provider based upon the data that we're using.  Within this tool, we're able to slice and dice the data to view our physician roster based upon the narrow networks that we have.  We can easily find a physician who might be part of a certain ACO, and keep patients within that network.”

That is good news for payers and patients, to be sure, but it also helps providers understand the flow of patients across the care continuum, identify gaps in care, and aid broader population health management initiatives.

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“A lot of the implementation process does have to do with physician buy-in and getting them to understand the importance of getting the right people in to the right providers,” Nicholson stated. “And the impact it has on their schedule and their practice.  At the end of the day, it impacts their schedule if they're not seeing the right patients.”

“We're starting to be able to provide feedback to our physicians – our employee groups and our affiliated groups – on a quarterly basis in terms of where our patients are going, what they’re looking for, and what gaps exist in their service areas in terms of providers,” she added.  “So they are seeing those benefits in terms of getting feedback to them on a consistent basis, whereas previously we weren't providing that feedback.”

Nicholson’s advice for other healthcare providers looking for ways to expand access to care and patient engagement is simple: start with an assessment of current patient management programs and flag potential opportunities for improvement.

“I think it may be worse than you think in terms of patient access,” Nicholson warns. “You need to identify what the challenges are for patients to get into your system.  And then before moving forward, make sure you have an idea of what your ideal state will look like. Speak to your patients.  What does it look like to them in terms of making that shift?”

“We haven’t quantified all the feedback we’ve received, but we’ve gotten a lot of patient notes and e-mails stating that it’s a positive change,” she said.  “Just the time that we've actually taken to find that right provider is important to them.”

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