Building a preferred network: strategies for better patient access

Becker’s Health IT & CIO Review, Dec. 16, 2016 – Christian Brown –

Every ACO and at-risk organization in the country is trying to build a preferred network of high quality providers.

The biggest challenge facing these organizations is how to connect their network in a meaningful way. As the payment model continues to evolve, payers, hospital systems and providers increasingly bear more risk. As a result, efforts to strengthen care coordination are a high priority for executives. The ability to control the key transaction behind every healthcare event, the appointment, tops the list. The appointment is what holds a patient’s care together and ultimately ensures that gaps in care actually close. Direct scheduling into disparate systems is the catalyst that unlocks greater access, increased efficiency and maximum accuracy within preferred networks.

If this is true, how do organizations take advantage of digital scheduling when key partners are on diverse systems? For example, many network providers and non-employed affiliates conduct their business on a variety of different EHRs, each operating in fragmented silos. How do you convince these providers to participate when they operate autonomously, outside of your control?

With such a diverse range of health systems and plans, there is no easy answer. The challenge of working with affiliate and network providers is that each bring a different set of approaches and objectives. The primary objections, however, are based on two basic myths. The first one is the belief that you must onboard the entire network before value can be realized. The second myth is that providers fear they will lose control of their calendar. Both of these concerns, while valid, can be addressed with a proven value case:
  • Financial: Even if just the high volume providers on your network implement online appointment scheduling at the outset, immediate reductions in medical cost for both providers and patients can be realized by avoiding penalties, reducing outmigration, improving referral capture, deflecting bad debt and new patient acquisition.
  • Clinical: Digital appointment scheduling deployed across a network shortens lead times (between the referral and the appointment), prevents unnecessary readmissions and improves follow-through on care.
  • Operational: For a new technology to improve a provider’s operations, it must improve staff efficiency while also protecting the provider’s calendar. Decision support drives better patient/provider matching, decreases no shows and improves accuracy of risk adjustment.
  • Visibility: Analytical data provides a valuable, real-time insight into activity that can be used to drive behavior change and make key clinical and business decisions.
Once the value case has been presented, the next hurdle can be even higher. What does it take to implement the new solution? While much of the technical integration (connecting HL7 feeds) can take up to ninety days, it is possible to begin scheduling well before that. New technology adoption often stumbles against a resistance-to-change mindset, and for good reason. It takes more than technology alone to make forward leaps in care coordination. But when providers realize that their scheduling rules benefit enormously when they can be tailored around their workflow needs and optimized through a consultative design partnership, the process itself earns appeal. While the technical teams configure the data feeds on the backend, the scheduling team needs a simple interface that demystifies the complexities of scheduling automation. When the setup process is seen as an opportunity to help clarify scheduling protocol, decision support can be optimized to protect the needs of practice and provider. The goal and outcome are the same: to connect the right patient with the right provider, at the right time, for the right reason.

The current way of scheduling patient appointments does not scale. For preferred networks, it’s even worse because of system-wide inefficiencies which fail to leverage high quality/low cost providers. Barriers such as fear of losing calendar control and new-tech-integration-fatigue do not factor how quickly a robust, decision support solution can be up and running. With up to 40% of healthcare referrals failing to take place today, consumer safety is at risk. Online scheduling simplifies the process for both patient and provider – helping preferred networks reach their full potential. A host of benefits become possible when appointment inventory is consolidated across disparate systems into a single platform. Provider networks stand to win surprising financial, clinical and operational benefits as care coordination focuses where everything must begin: the appointment.

See the original article on Becker’s Health IT & CIO Review.

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