Report: How progressive organizations are “retailizing” their service lines

LA County's e-Consult Service

LA County's health care system implemented its e-Consult program to provide faster access to specialist care for its low-income patients. A visit with a primary care provider (PCP) serves as a triage point: PCPs address the issues they can and then submit queries to a specialist, who return advice within 24 hours. The specialist can suggest specific treatments or recommend an in-person visit.

This improves access for e-Consult users, who can receive specialist attention through a visit with a PCP. It also provides faster access for in-person visits: Nearly 25% of the requests submitted by PCPs were resolved without the patient needing to see a specialist, which enabled specialists to expand their panel size and reduce time-to-next-available appointment. In fact, about 30% of patients who needed an in-person visit with a specialist in 2015 got one within 30 days, up from 24% in 2014.

What do consumers want from specialty care?

Keys to this model's success include:

1. Virtual visits: The program provided patients access to specialist treatment without the need to make an in-person specialist appointment. This expanded the specialists' panel size, while also reducing the need for the patient to make an often costly and time-consuming commute to the doctor's office.
   
   
2. Physician buy-in: The e-Consult platform also won physician buy-in. Many PCPs appreciated the opportunity to treat a wider range of ailments, and specialists valued the tool as it allowed them to focus their appointments on the patients they deemed a priority.

Using APs to expand access to particularly anxious oncology patients

Seattle Cancer Care Alliance trained their schedulers to identify newly diagnosed, highly anxious patients and direct them to their Now Clinic. By offering an initial appointment with a nurse practitioner (NP), the Now Clinic can see these patients in one-to-three days. The NP educates, orders other necessary tests, and discusses next steps. Consumers love the improved access: 94% of Now Clinic patients stay with SCCA for treatment, compared to 65% of patients who come through the traditional clinic.

Keys to this model's success include:

1. Scoping the patient pool: Not all patients are proactively offered an appointment at the Now Clinic. For example, second-opinion seekers are directed to the main clinic. Scoping down the eligible patient pool makes rapid access more feasible.
   
   
2. Advanced practitioners (APs) supplement access: For many highly anxious patients, seeing anyone provides more comfort than seeing no one, so the AP extends access through an early consult.

Bringing urgent care to orthopedic care

Anne Arundel Medical Group's orthopedics and sports medicine specialty started their OrthoTODAY service to offer immediate access to all patients experiencing non-life-threatening injuries such as fractures, sports injuries, and cast or wound dressing problems. For routine orthopedics services such as chronic problems or second opinions, the service routes patients through their main orthopedics office. The program runs for extended hours, six days a week, significantly expanding patient access.

A key to this model's success is:

1. The focus on a highly shoppable service line: Specialties such as orthopedics, imaging, and oncology see more patients who are likely to shop for care, so offering quick access can attract self-referrals.