Healthcare reform and the shift toward value instead of volume underscore the importance of population health management for improving patient outcomes on a large scale. One essential component of a comprehensive population health program is patient access.
With healthcare reform now opening the door to more insured patients who have greater say in where they go for care, having a robust patient access strategy at the center of population health initiatives is becoming paramount.
The role of patient access
There are four key benefits to enhancing patient access within population health management:
- Prevents emergent situations. Ready access gets patients into care faster. In previous years, it could take patients six to eight weeks to schedule a specialist appointment, today’s patients will simply go to the emergency department or outside the health system entirely rather than wait. When patients choose to go outside the system, hospitals lose the ability to monitor care quality and costs, and miss out on potential revenue. By prioritizing patient access, hospitals can avoid these negative consequences and ensure patients don’t go to the ED for preventable situations.
- Builds effective patient engagement. Better engagement often means more patient compliance with treatment plans, especially when it comes to chronic conditions. Greater access helps strengthen compliance as a first step toward improving patient outcomes and getting patients on the road to wellness.
- Enhances patient satisfaction. When healthcare organizations make it is easy for patients to interact with their providers, patients are less likely to go elsewhere for care. Increased patient satisfaction, in turn, drives up value-based physician compensation.
- Improves communication through shared records. More transparent information exchange is an essential component of an effective population health initiative. A patient portal, for instance, allows the patient and physician to communicate, share test results and ask and answer questions in a timely manner. This helps the patient avoid retests and unnecessary expense, while the provider circumvents lost reimbursement opportunities.
Providers should expand patient access because it impacts not only care quality and reimbursement, but also market competitiveness. In some markets, a strong access program provides a competitive edge, while in others it has become an absolute necessity for remaining current, as competitors deliver easy access and consumers expect it from all market players.
5 steps to incorporate patient access into population health strategies
While there is no exact formula, the following steps represent one approach that can lead to enhanced clinical and financial performance:
Step 1: Understand the organization’s strategic goals regarding population health.
Pursuing a population health strategy is no longer an option for healthcare organizations as reimbursement shifts to value-based models. Therefore, the first step is to understand the path to population health the organization wishes to follow. Does the strategy include risk-based contracts, or participation in an accountable care organization? Once an organization outlines its goals, it should determine how patient access factors into these goals and the best options to support them in the long run.
Step 2: Assess the current position.
A key activity for understanding patient access is to define the measures that demonstrate current performance and then gather baseline data. These measures may be cost and/or quality indicators, such as total patient volume; new patient volume; referral scheduling times; preferred next available appointment; registration accuracy; acute appointments in 24 hours or routine appointments not in seven days. Organizations should identify top performers in the industry and benchmark against them. This benchmarking approach can help create the business case for patient access and demonstrate the best practice.
Step 3: Identify operational and organizational change opportunities.
Standardizing and consolidating processes can streamline information capture and reporting on both the front and back end, which ultimately speeds access while reducing the cost to collect and improving payment timing and accuracy. For instance, organizations may want to examine their processes for physician scheduling to determine if standardizing appointment types and providing access to physician calendars can help patients get into care quicker and more efficiently. Likewise, standardizing information capture at registration can support greater accuracy, consistency and more exact billing. In addition, automating eligibility can reduce rework and denials on the back end.
Step 4: Maximize avenues for patient access.
It stands to reason that the more opportunities a patient has to interact with an organization, the easier access will be. For example, a patient portal provides several entry points for communication, facilitating online scheduling and appointment booking and promoting better patient-physician interactions through direct messaging. Other paths for patient access involve mobile solutions, texting and social media as well as focused and responsive telephone communications.
Step 5: Establish a structure for ongoing support.
Recognizing the need for smoother patient access and retooling workflow are not enough to sustain long-term performance. Organizations need to create an enterprise-wide governance structure to support patient access initiatives and ensure attention remains on them. Organizations should also assess progress over time, comparing defined measures to a baseline to note success and continuing improvement opportunities.
It is generally agreed that organizations that better manage patient outcomes and the costs of care will improve population health and protect their revenue streams in a value-based world. As more patients enter the healthcare system, patient access tactics that are part of a broader population health strategy stand to elevate quality while reducing cost, ultimately sustaining an organization’s financial viability.