According to BCH leaders, some of the key challenges affecting the primary care service line were increasing physician burnout, lack of standardization, and long appointment wait times.

To expand access and reduce variation, BCH standardized scheduling templates across its clinics. This change also helped to promote consistency across BCH's different primary care clinics.

Leaders first analyzed scheduling data to identify the most common types of visits and align them to a new list of standardized visits. Each visit type had a standardized duration, which helped drive schedule utilization.

Session limits were used to set the maximum number of visit types or group of visit types that could be scheduled during a given time period to maximize schedules and enable auto-scheduling functionality. Clinicians' schedules also included "balance time,“ a defined, unavailable timeslot that helps accommodate visits running over time and allows clinicians to fulfill other responsibilities, such as charting, documentation, and patient messages.

Leaders used an access dashboard to monitor adherence to scheduling standards and met with clinicians regularly to determine if any adjustments to the templates were needed.

Leaders created a new, centralized administrative medical assistant (MA) position to help streamline MA roles and responsibilities. This position worked with all primary care providers to reduce their administrative burden by handling tasks related to pre-visit prep and prior authorization. The administrative MA also helped optimize in-clinic workflows by resolving as many patient care gaps as possible prior to a visit, which allowed providers to spend more time with patients.

The new role had a swift impact on providers working at the clinics, with one saying that they had already noticed the volume of messages decreasing due to the administrative MA handling pre-visit prep work.

Leaders implemented a team-based care model to help streamline workflows and promote top-of-scope responsibilities. The clinics paired providers and MAs in a 1:1 ratio, with additional support provided by a team of administrative MAs.

Taking a team-based approach helped to ensure continuity of care for patients across BCH's primary care practices, which in turn improved their experience. This model also helped distribute the workload more appropriately across the care team, leading to reduced burnout even as visit volumes increased.

BCH's primary care leadership was empowered to be accountable for department performance. Leaders also worked to ensure staff had administrative support to increase adherence to new workflows and schedules.

These changes helped strengthen the organization's dyad leadership model and set up the foundation for a formalized leadership structure to be implemented within BCH's existing governance model. They are in the progress of launching this leadership structure, the Primary Care Advisory Committee, which will enable more effective decision-making and allow more centralized services to be implemented.

Implementing a reporting dashboard helped hold operational and clinical leaders accountable to both individual clinic and group performance. This comprehensive dashboard validated data from several different sources and included focused metrics with specific baselines and targets to meet, which helped leaders evaluate performance over time. Using the dashboard, managers can quickly and easily access performance data for their clinics and individual providers.

An ambulatory leader at BCH emphasized the value of the dashboard, saying that it let them assess the performance of the primary care service line across multiple dimensions in a single location.

BCH also conducted a series of manager competency trainings aimed at promoting standard work, ensuring continuous improvement, and supporting data-driven decision-making. These trainings focused on financial management, operations, communications, and strategic plan alignment, particularly for value-based care and network integrity.

The trainings helped promote cross collaboration across the different clinics and pushed managers to work as a broader team instead of focusing solely on their own clinics. These changes helped leaders be more proactive instead of reactive about addressing problems throughout the service line.

Note: All information in this case study came from Advisory Board interviews with leaders from Optum Advisory.