The Multidisciplinary Challenge of Improving Patient Access to Care A Discussion with Lehigh Valley Physician Group.

Transcription

1 The Multidisciplinary Challenge of Improving Patient Access to Care A Discussion with Lehigh Valley Physician Group October 3, 2017

2 2 About Us Michele Molden Senior Vice President Advisory Board Michele leads Advisory Board Consulting s patient access engagements and works with clients to achieve financial and operational sustainability for the system, inclusive of both hospital and physician group strategy and operating performance. James Demopoulos, MHA, MPH Senior Vice President Operations Lehigh Valley Physician Group James has spent over 30 years in group practice leadership with some of the largest health care systems in the northeast. He currently leads the access and patient experience group practice initiatives at Lehigh Valley Physician Group. For Technical Questions During Today s Webconference: Please contact Erika Renson using the chat function in the webconference panel or by RensonE@advisory.com

3 ROAD MAP 3 1 The Multidisciplinary Challenge of Patient Access 2 Introducing Lehigh Valley 3 Lehigh Valley s Journey to Solve Patient Access Through Applied Science 4 Questions and Next Steps

4 4 The Next Era of Health Care Reform? No-regrets priorities remain the same Accessibility Multi-channel navigation platform, including search, price estimation, and triage/scheduling helps streamline transactions Development of diverse network of access points (e.g. urgent care, retail, enhanced access to specialty care, primary care) to meet varied consumer access demands Reliability Organization-wide commitment and investment in service delivery and quality improvement drives broad engagement in delivering superior outcomes High-reliability approach to both service delivery and clinical quality ensures baseline of performance Affordability Willingness to partner with lower-cost providers offers patients affordable options, helps prevent markets from becoming overbuilt When markets are already overbuilt, commitment to scale back excess capacity ensures affordability in the long-term In our 2017 Health Care CEO Survey, C-suite executives rated improving ambulatory access as their top issue Source: Health Care Advisory Board interviews and analysis.

5 5 Patient Access Is the Linchpin Inhibiting or enhancing performance in both worlds Maximize provider productivity z Increase patient panels Expand practice capacity VOLUME VALUE Engage patients in care plan Drive downstream referrals Manage network integrity Patient Outcomes on the Line Limited Access Timely Access Avoidable ED Visits Preventable Admissions Reactive Care Quality Outcomes Managed Diseases Preventive Care

6 6 Access Breakdowns From the Patient s Perspective Patient Struggles to Get In to Clinic Office Has Bottlenecks Navigational Support Is Fragmented Appointment Scheduling Struggle to reach appropriate scheduler on phone Provider unavailable within desired timeframe Arrival and Registration Patient queues and waiting room overflow Inefficient, incomplete registration Referral Management Unmanaged, untracked referrals Disjointed follow-up scheduling communications Finding the Office Inconvenient clinic location, parking Confusing signage and branding Seeing the Provider Exam room use and turnover bottlenecks In-room delays and rushed visits Why is this so hard? What s taking so long? Where do I go next?

7 ROAD MAP 7 1 The Multidisciplinary Challenge of Patient Access 2 Introducing Lehigh Valley 3 Lehigh Valley s Journey to Solve Patient Access Through Applied Science 4 Questions and Next Steps

8 8 Introducing Lehigh Valley Lehigh Valley Physician Group 1,450 employed providers 200 practices 2.5 million annual visits 3,500 colleagues Lehigh Valley Health Network 8 Campuses, 18,000 employees Top 30 U.S. NWR, Top 50 Healthgrades, MSK Partner Recipient of 2017 Vizient Quality Leadership Award for AMCs 2017 The Advisory Board Company advisory.com

9 9 Background Lehigh Valley Health Network, 2015 Network-Wide Goal In 2015, goal to improve access and patient experience overall Triple Aim Better Health, Better Care, Better Cost Critical to success of ACO, PCMH model, overall growth, clinical outcomes, population health, coordination and continuity of care, payer and employer partnerships, colleague satisfaction and the patient experience/value 2017 The Advisory Board Company advisory.com

10 ROAD MAP 10 1 The Multidisciplinary Challenge of Patient Access 2 Introducing Lehigh Valley 3 Lehigh Valley s Journey to Solve Patient Access Through Applied Science 4 Questions and Next Steps

11 11 A Bundled Solution Set Affinitizing patient survey results with selective solution bundles 2017 The Advisory Board Company advisory.com

12 12 A Three-Pronged Project Scope FY 16 Accelerated LVPG Strategic Plan Pilot Practices Deep dive implement access solution bundles MPC FY16 Neurology LVPP LVPP - SP Endo Oncology Women s Med Children s Focused Replication practices with greatest opportunity Broad Improvement Patient experience teams in all practices (QMAP) Clinical Intelligence/Epic Optimization/Capacity Management: Implement Epic Welcome, Pre-Visit Planning, Rx Management, e-visits, provider efficiency profiles, MyLVHN self-scheduling, expanded hours, TBD pilots Templates, Telecomm, Clinical ATC, MyLVHN engagement, practice profiles, enterprise scheduling, advanced practitioner utilization, Exceptional Experience staff training: Implement countermeasures & leverage collaborative leadership of practice triads across all practices 2017 The Advisory Board Company advisory.com

13 Bundled Solution Example 13 Deconstructing Provider Templates Countermeasure: 1.1 Streamline Visit Types Job Aid Bundle: 1.0 Deconstructing Provider Templates Why Multiple visit types create a more complicated template and barriers to finding an appointment. Components Key Points/Best Practice Alternative Solution(s) Reasons Role What? The logical steps to advance the work Optimize Number of Visit Types Standardize Visit Types Analyze actual duration vs. slot duration How? Tips that will make or break, avoid injury, make it easier Primary Care: Follow Standard Visit Types Established by LVPG Leadership (Link to documentation) LINK TO EPIC REPORT Specialty Care: 1) Look at which visit types are being used most often. 2) Remove visit types that are not frequently used. 1) Standardize length of each visit type 2) Standardize how/when visit types are scheduled throughout the practice 3) Follow Standard Work for scheduling patients with those established visit types. INSERT EXAMPLE DOCUMENT LINK 1) Review the actual cycle time compared to visit duration in EPIC DAR. 2) Visit duration includes the actual clinical time a patient interacts with a provider. INSERT LINK TO MPC EXAMPLE Discuss with practice leadership what visit types are necessary for scheduling accuracy. Create standards on when each visit type should be used. Why? Resons for key points Who? Multiple visit types create a more Practice complicated template and barriers Manager/Pract to finding an appointment. Creates ice Lead/ a stremlined process for enterprise Office Coordinator scheduling. Variations in scheduling practice create more burden for enterprise scheduling. Providers may request longer durations for visits. Durations should be close to actual time. Practice Manager/Pract ice Lead Practice Manager/Pract ice Lead Analyze scheduling slots and blocks. 1) Reduce blocks in schedule for administration, meetings, and chart prep. Utilize the Daily Management 2)Track the number of open appointment System to review open slots on a blocks being saved for acute appointmemts daily basis. Communicate open slots INSERT SAME DAY ILL TRENDING with providers. REPORT LINK (EA PUBLIC NCG DATA) Block in schedules are direct obstacles for patient access. Practice Manager/Phys ican Lead Reduce Provider Preferences Balance Clinical FTE and NON Clinical FTE time 1) Open schedule templates to allow for any visit type at any time, based on patient preference 1) Compare contractual clinical time to what is built in EPIC template LINK TO DASHBAORD REPORT WHEN AVAILABLE Provider preferences often create Practice scheduling blocks for certain types Manager/Pract of appointments. This blocks ice Lead patient access. Practice Manager/Pract ice Lead 2017 The Advisory Board Company advisory.com

14 Bundled Solution Example 14 Deconstructing Provider Templates Schedule Capacity Sample Clinical FTE cfte A Legend Gray: Key columns Black and White: Potential capacity in schedule B Expected Clinical Hours Potential Capacity Epic Scheduled Hours (OP Practice) Cancel, Bumps, No-Show Hours Epic Completed Hours (OP Practice) 2017 The Advisory Board Company advisory.com

15 Bundled Solution Example 15 Deconstructing Provider Templates 2017 The Advisory Board Company advisory.com

16 Bundled Solution Example 16 EMR Optimization Patient Engagement Strategy MyLVHN Initiatives Year 1 Aug 15 Sept 15 Oct 15 Nov 15 Dec 15 Jan 16 Feb 16 Mar 16 Apr 16 Wave 1 - Optimization Comprehensive strategy to drive MyLVHN signup and utilization Patient Entered Questionnaires ROS, HPI, Subset Specialty Pilot Go Live LVPG Go Live May 16 June 16 E-Visit Pilot Go LIve MyLVHN echeck-in Go Live Video Visit Pilot Go Live Appointment Cancellation Patient Self Scheduling Well Visits Primary Care Completed items: View labs, graphs View/download/transmit AVS Text message appt reminders 2017 The Advisory Board Company advisory.com Pilot Go Live Request refills Proxy access/view Care everywhere auth MyLVHN Bedside Patient Self Scheduling Well Visits - Pediatrics Pilot Go Live Mobile App Enhancements

17 Bundled Solution Example 17 EMR Optimization Patient Engagement Strategy MyLVHN Initiatives Year 2 Nov 17 Oct 17 Sept 17 Aug 17 Jul 17 June 17 May 17 Apr 17 Mar 17 Feb 17 Jan 17 Dec 16 Nov 16 Oct 16 Sept 16 Aug 16 Video Visit Go Live Open Scheduling Pilot Go Live Open Scheduling Expansion Direct Scheduling (Sick Visit) Expansion Go Live Waitlist Appointment Offer (Fast Pass) Go Live Check-In Welcome Tablets E-Visit Expansion 2017 The Advisory Board Company advisory.com

18 18 Where are we now? Improvements in patient experience and patient access go hand-in-hand 87% 91% Overall improvement in patient experience over 12-month period Equates to moving from 37% to 64% in national ranking +13% Increase in completed appointments over 9- month period

19 19 Where are we now? Operations Dashboard outcomes after year 1 Operations Dashboard Results Achieved Productivity Provider schedule utilization improved by 8% for APCs and 5% for physicians Same day block utilization improved by 30% for APCs and 10% for physicians Efficiency Outpatient practice visits increased by 10.5% 79,178 enterprise visits scheduled Engagement 111,001 patients activated on patient portal In-network referral capture rate reached 84% Expansion New patient visits increased by 49% New patient lags were improved by 2 deciles for primary care and 1-2 deciles for specialty care

20 20 Where are we now? Significant improvements in CAHPS scores

21 21 QMAP for Continuous Improvement Ops & Physician Practices Development Team 1 2 QMAP Template/ Solution Bundles Develop Action Plan/ Countermeasures 1. Survey results 2. VOC/QFD analysis 3. ID solution bundles 3 Define and Report Improvement Metrics 4 5 Implement Changes Report Progress/ Did the Metric Change? 1 Yes No Begin next cycle 4. ID countermeasures aligned with solution bundles 5. Define process metrics for each countermeasure 6. Develop job-aids for implementing countermeasures

22 ROAD MAP 22 1 The Multidisciplinary Challenge of Patient Access 2 Introducing Lehigh Valley 3 Lehigh Valley s Journey to Solve Patient Access Through Applied Science 4 Questions and Next Steps

23 23 Key Takeaways The emerging competency of patient access requires clear sponsorship within an organization to set a purpose and vision that spans the patient journey Expanding patient access to care is a multidisciplinary challenge that involves matrixed capabilities across often disparate functions of an organization It takes an investment in organizational development to move from pockets of access to a network-wide strategy and solution

24 24 For Help with Patient Access to Care Advisory Board methodology DEFINE GOALS 1 6 Engage Key Stakeholders Embed Culture of Accountability 5 2 Evaluate Performance and Operations Establish Structure for Alignment 4 3 Assess Local Market Dynamics Present Conceptual Frameworks DESIGN STRATEGY DELIVER IMPACT

25 25 Next Steps Providing your feedback Designing and operationalizing a plan to advance access to care Fill out the Survey Please take a moment to provide your thoughts on the presentation and. Once the presenter exits the webconference, you will be automatically directed to an evaluation. Learn More About Tailored Support How your organization s unique needs and initiatives around access can be deployed with boots-on-the-ground support

26 26 Interested in Learning More? This session is part 1 of a 3-part series about advancing access to care. Join us for our other upcoming sessions: Decisions by Analytics Seeking feedback on a new access-to-care platform Thursday, October 5, p.m. - 2 p.m. ET Transforming Patient Access to Care A discussion with Einstein Healthcare Network Tuesday, October 10, p.m. - 4 p.m. ET To learn more and register for these sessions, visit advisory.com

27 27 If You Would Like to Ask a Question Questions Panel Simply type your question and click Send. This will let the presenter know you have typed a question. Enter a Question in the Questions Panel

28 28 Get in Touch With Us Michele Molden Senior Vice President Advisory Board James Demopoulos, MHA, MPH Senior Vice President Operations Lehigh Valley Physician Group For more information, or to speak with an Advisory Board team member, complete the survey at the end of this webconference or contact Erika Renson at

29 29 What Did You Think of Today s Session? Please Take a Minute to Complete Our Evaluation Once you or the presenter exits the webconference, you will be directed to an evaluation that will automatically load in your web browser. Please take a minute to provide your thoughts on the presentation. Thank You!

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