Well-documented are the studies pointing to a significant provider shortage in the United States. A 2017 study commissioned by the AAMC forecasts a shortfall of between 40,800 and 104,900 physicians by 2030, of which 7,300 to 43,100 are primary care physicians. This shortfall, driven by demographic factors, will exacerbate widespread challenges already prevalent in obtaining timely and appropriate healthcare.
These challenges are most acutely observed in ballooning wait times. Case in point: the VA has come under intense scrutiny for its lengthy wait times, and earlier this year launched a website publishing appointment wait times at all of its facilities in an effort to help patients find more timely care.
But veterans are not alone in experiencing delays in getting access to care: a recent study sponsored by the Robert Wood Johnson Foundation and conducted by Oliver Wyman and the Altarum Institute found similar challenges among vulnerable populations, including Medicaid beneficiaries, low-income individuals, the uninsured, Spanish speakers and family caregivers. For these health consumers, better access to care is a top priority. Specific needs include:
- More providers who accept their insurance
- Easy online appointment booking
- Expanded doctors’ hours
- More clinics nearby
At the same time, there has been a proliferation of new solutions – including retail clinics, telemedicine offerings, video and e-visits, concierge medicine, and more. While these solutions do create access to providers, they remain bespoke solutions that must be integrated if they are to produce a durable and more value-based solution. Hence, the future of “good” access rests on the effective knitting together of these solutions with more traditional ambulatory care options in a manner that works well for consumers.
Building an integrated access solution
Providers have a critical role to play in these efforts, and they stand to create disproportionate benefit for both their communities and themselves by doing so. In the face of decreasing inpatient admissions and compressing reimbursement, providers that produce an accessible healthcare solution stand to win lives – and the corresponding healthcare delivery that they will demand.
In our experience working with health systems to improve access, success requires a mix of analytical and operational capabilities aimed at identifying and addressing the choke-points that patients encounter across the continuum of care. A successful approach begins with primary care – the “top of the funnel” – and connects to specialty care and related services as patient flows dictate.
Our team has deployed such models with several organizations, which allowed these systems to:
Track and monitor access metrics: Time-to-third-next-available appointment (TNA) and office wait times are widely used measures of access. Highly successful organizations track these and other metrics at a very granular level to identify pain points and accurately match provider supply with demand.
Reduce unnecessary variation: Streamlining provider schedules and workflows can release trapped capacity, allowing providers to see more patients and on shorter notice. Reducing appointment types is often an effective first step in this process.
Practice “top-of-license” care delivery: Deploying APPs and PAs as part of a collaborative care team can free up physicians to grow their practices and/or spend more time with high-need patients.
Offer extended hours: There is significant patient demand for services outside traditional office hours, as evidenced by the success of retail clinics. Staggering provider schedules to support evening or weekend hours can redirect some of that demand.
Above all, successful organizations keep the patient top of mind and begin to focus much more on measures like net promoter score (or related metrics) as their barometer of success. Further, these systems continually assess the care continuum looking to balance their asset mix in a manner that elevates consumer satisfaction, in addition to economic contribution.
Market trends are exposing fault lines in providers’ traditional model of care delivery. Gone are the days of six-week wait times as hallmarks of good market standing. The emergence of innovative models unified in their aim to provide convenient and timely care, coupled with increasing financial pressures, points to a future of care delivery in which a patient-centric access model is paramount for providers’ success.
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