Trinity Health significantly reduced its operating losses and increased its positive cash flow margin in the first six months of the 2024 fiscal year, and President and CEO Michael Slubowski has a plan to continue improving enterprise-wide financial health, focused first on access to care.
"Access had a lot of challenges through the pandemic, including staffing shortages and a reluctance of community members to come back for care," he said. "What we've really done, especially with our community division is to put a renewed focus on creating open schedules and access to accommodate the care needs of our communities. That includes our medical groups and our diagnostic and other ambulatory services."
The national health system based in Livonia, Mich. is using Qualtrics to ask patients questions after they schedule visits to gauge the consumer experience around access to care. Those questions include whether they secured an appointment in the expected timeframe. Filling appointments and providing easy access will meet patient needs and bring additional revenue into the system.
"Opening up access has the most potential to improve our financial performance," Mr. Slubowski said. "There is always the demand versus supply curve, and the reality is if people don't get access to the system within the timeframe they are expecting, they will go somewhere else."
Trinity is improving access through the use of MyChart in its TogetherCare initiative, powered by Epic, which the system has spent the last several years implementing as a common EHR platform enterprise-wide. The system can provide real-time feedback from patients through Epic and Qualtrics consumer engagement questions.
If the system is successful in bringing in more patients, hospitals will also need new staffing models to accommodate more patients at a lower cost structure without closing beds. Trinity developed a model called TogetherTeam Virtual Connected CareTM, which now covers around 2,000 of the system's beds. The TogetherTeam model includes a three-person care team consisting of a floor nurse, a certified nursing assistant (CNA) or licensed practical nurse (LPN) and a virtual nurse to meet patients' needs.
"Our experience so far is that our retention of early career floor nurses has improved dramatically," said Mr. Slubowski. "The CNA and LPN are practicing at a higher level of capabilities. We initially thought there would be a lot of Trinity Health nurses leaving the floors to join the virtual nursing staff. While some of the more experienced nurses seeking fewer physical demands have joined the virtual nursing team, we've also recruited a lot of experienced nurses from the outside to join us. It's been a great opportunity for us."
Mr. Slubowski said patients and families love the flexibility of being able to call the virtual nurse and have conversations right away with questions about their care, and the virtual nurses can also do teaching and discharge planning.
"We are firing on all cylinders with TogetherTeam to bend the cost curve and improve care, nurse retention, patient satisfaction and throughput," said Mr. Slubowski.
On the revenue side, Trinity expanded its Medicare Advantage plan to five states to capture total cost of care and outcomes for its populations served. The system is also doing more work on payer contracting, including a recent initiative with Anthem to achieve fair payment and support value-based care.
"It's a better partnership model and it helps us improve revenue and reduce administrative complexity," said Mr. Slubowski. "For example, Epic has a new capability with its Payer Platform where we can exchange claims and clinical information electronically and adjudicate those claims electronically. It saves the payer and provider a lot of money in administrative turnover and waste in processing claims."
Finally, Trinity Health is scaling initiatives to redesign system administrative and support services (SASS) to lower overhead expenses and become more cost effective. The health system reorganized those functions from a traditional decentralized model to four service areas in which it can utilize system support staff and capabilities more efficiently over multiple regional health ministries. This adjustment can improve service and lower costs.
"That's a major element of system administrative services and staff redesign, and it's about implementing a very effective matrix management model for people, process, technology and culture around those services," said Mr. Slubowski. "We have three virtual service centers around revenue cycle, but all those people are under a common leadership structure and all processes and payer contracting is done in a uniform way."
Trinity is also in the final stages of implementing Epic EHR systemwide and can now use MyChart for clinical and revenue platforms. The system uses Workday for human resources with its 110,000 colleagues, and uses Oracle’s PeopleSoft as the common ERP for financial functions.
A few years ago, overhead for system administrative and support services was 11% of revenue; since the reorganization, it has dropped to 9.7% and is headed down to 9.3%, said Mr. Slubowski.
"We are well under way to have the SASS program implemented across the whole ministry," he said.