On-demand access is the new baseline
Responding to a precipitous decline in in-person volumes brought on by the epidemic, physician groups quickly stood up telehealth and flexible scheduling models and started offering care outside of their typical hours. As a result, patients now perceive their physicians as far more accessible than they were before—and patients don't want to go back. As medical groups shift their focus to recouping the volumes they lost during Covid-19, it will be critical to approach access from the patient's perspective.
Sentara's patient-centric approach to access
Even before Covid-19, physician executives started to realize that traditional access metrics—such as time to third next available appointment—fell short. Many leaders found their data wasn't actionable and didn't reflect what patients want. In recent years, we started to see patient-reported access metrics gain traction across the industry. As executives focus even more on delivering care that aligns with patient preferences, we expect that these metrics will become even more common.
Sentara Medical Group, a health system employed physician group that spans Virginia and North Carolina, was an early adopter of patient-centric access metrics, rolling them out in three steps:
- Picking the metric: A few years ago, Sentara decided to overhaul its primary care access strategy, including selecting new performance metrics to track. Sentara aimed to put the patient at the center so it opted to use a question from its CG-CAHPS patient experience survey (Sentara uses NRC Health as a vendor) that measured access from the patient's perspective: "In the last 6 months, when you contacted this provider's office to get an appointment for care, how often did you get an appointment as soon as you needed?" This metric differed from previous measures Sentara had tracked because it was based entirely on the patient's perception of access.
- Establishing a benchmark: To make this metric more actionable, Sentara paired it with further data collection to better understand specific patient preferences. Sentara came up with a standard set of questions that it implemented into call center workflows for 12 months across its 200 primary care practices. At the point of scheduling, call center staff asked patients when they wanted to come in for their visit: same or next day, in two to seven days, or in eight to 28 days. Sentara then surveyed patients again after their visit to track whether patients ended up receiving care within their desired timeframe.
- Responding to the data: By collecting this data, Sentara was able to quantify both when patients wanted to be seen, and how well it was meeting those expectations. This information helped Sentara prioritize its access expansion efforts according to patient preferences and its gap to goal. For example, the data revealed that Sentara lagged the most in same- and next-day access, so it focused its initial efforts there by opening up five same-day appointment slots per provider.
Early signs of success
As a result of these steps, Sentara jumped from the 43rd percentile up to the 72nd percentile in performance on its new access metric across 18 months. On average, it's also getting 88% of patients in within their desired timeframe in primary care. Sentara also continues this data collection and measurement at regular intervals to ensure that it's continuing to meet patient access preferences as it evolves.
Beginning in 2020, all Sentara Medical Group practices moved to a new patient-reported access metric: "Did you get an appointment when you needed one?" This question will broaden the patient's perception of access to not only include acute or same-day appointments but all appointments they request. Sentara's performance goal is to achieve an answer of "Yes Always" 91% of the time.