Practice Notes

Why your patient access issue is bigger than you think

by Michele Molden, MBA, FACHE and Susan Neves, CPA, MBA

About once a week, we get a call from a medical group executive that goes something like this:

"I was hoping I could solicit your help improving patient access. We've been thinking about [building a call center/redesigning scheduling templates/hiring more clinicians]."

Each of these projects may be a great idea, but there's a problem that unites all of these conversations: they're oriented around a narrow project, instead of a broader vision.

Whenever we get a call like this, we challenge leaders to take a few steps back from obvious pain points, and get to the root of the problem before making changes across the medical group.

What is the root of your patient access problem?

We find that many leaders share the same basic goals for patient access. Most medical groups want to enhance their patients' ability to reach the right provider, at the proper site, without barriers or confusion.

But if you deconstruct that statement, you start to appreciate the complexity and multidisciplinary nature of patient access and why it's so important to set an intention that will guide all other strategies.

Let's break it apart.

Patients' ability: Who are the patients that matter to your specific access initiatives?

The answer to this question has a major impact on how one would organize and prioritize the surrounding processes. For example, expanding access to an under-insured population that relies on public transportation would require a very different approach than for a commercial population that might want 24/7 access, or an older Medicare population for whom access requires not just capacity, but continuity of care.

Right provider: How do you work out the "right provider" for each patient and scenario?

There are times when patients need to see their primary provider. But other times, patients need to get in quickly—even if they see a different doctor or an advanced practice clinician (APC) instead. Access expansion efforts must incorporate a process for identifying which clinicians patients need to see, and helping patients optimize on a variety of different parameters, where "right provider" isn’t always "primary provider."

Proper site: How do you determine the proper site of care across different scenarios?

In addition to algorithms around what provider to assign, there are protocols to determine. When is it more important to be seen at any location than to be seen at the most convenient one? When should patients funnel to the local urgent care or another resource to keep them from the ED? When does a virtual consult makes more sense than a brick-and-mortar visit?

Confusion: How do you control for confusion in care delivery?

Patient confusion can happen anywhere—from scheduling a visit, to driving around the parking lot, to paying for the office visit, and then scheduling a follow-up. And the impact is significant: our research shows that if a referred patient leaves the physician's office without the next appointment scheduled, they are far less likely to schedule that next visit at all. Across the medical group there needs to be a coordinated infrastructure, through technology and dedicated staff at the point of care, to support patient navigation beyond just getting that first appointment.

Since patient access truly means something different to everyone, the first step to solving it is defining the term "access" and the medical group's ambition instead of running after narrow projects.

Reach out to learn more about how we support comprehensive patient access initiatives.

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