Most of us are drawn to healthcare because of an intense desire to help care for patients.
The very practice of medicine is built around each individual patient - from the narratives we recite on morning rounds to the way our charts are organized to catalog a patient’s health. So it is not surprising that so much of the push from technology over the last two decades has been oriented around the patient - from population health analytics to consumer health sites.
While understanding (even predicting) patient outcomes can provide critical insights, comparably little attention has been paid to the other side of the supply-demand equation - the providers themselves. Many health systems arose through loose affiliations with local providers who often had shared time together in training and looked to each other as “go-to” resources for a broad range of conditions. A primary care doctor might send issues relating to the shoulder, knee, spine, hip and ankle to the same orthopedic surgeon because they provided ready access for their patients (and perhaps a holiday basket at the end of the year). Some providers might even be able to call upon the Chair of Cardiology - but often without much consideration as to the sub-specialty clinical focus of that physician.
Several recent trends have exposed the limitations of this legacy system of referrals. First, the practice of medicine has become increasingly super-sub-specialized - supported in many cases with patient outcome data highlighting the importance of clinical volume and provider focus. Providers who “dabble” across too many conditions, risk statistically harming patients compared to their more narrowly specialized peers. As such, it is critical that providers are engaged for the conditions they are best suited to address.
At the same time, physician group and hospital M&A have brought together previously disparate providers, creating a large potential network for care but often without the right information to optimize the utilization of its most important asset - the providers themselves. In this setting, many providers continue to lean on pre-existing referral relationships - unaware that new providers might provide more relevant expertise and/or accessibility. The juxtapositions of physician groups are exacerbated by the hospitalist trend which eliminated many of the historical interactions that community physicians might have had with their hospital-based colleagues.
Finally, even if a health system wanted to pay more attention to its provider network, it was hard to know what to aim for. Very few organizations have had granular insight into the demand side of their network - for example, quantifying how many foot and ankle cases might need to be managed over the course of a year (much less how many of them might prefer a Spanish-speaking provider who took a specific kind of health insurance). As such, health system growth strategies have had to rely on macro assumptions about overall market share and economic leverage rather than optimizing a supply-demand marketplace.
Not surprisingly, the anticipated benefits of mergers have proven elusive in many cases. For many health systems, out-migration of patients to other organizations can be 30-50% of their volume while in many cases up to 40% of the appointment slots across their network go unfilled - a phenomenon we have coined as the “Patient Access Paradox.” Even when care stays within the provider network, misdirection of referrals to the wrong specialist – which occur in as many as 25% of the cases – can lead to patient and physician frustration, delays in care, and even economic penalties.
Imagine if another industry operated like this… Well it turns out, one did have very similar capacity utilization challenges a generation ago and the model for how they drove efficiency into their marketplace can provide a guide for how we can help ensure that patients get to the “right” providers, that providers practice at the top of their license, and that health systems realize enormous operational and financial benefits.
In 1990, every time an airplane took off in the US, almost 4 out of 10 seats were empty. What transformed that industry (and helped drive seat utilization to almost 90%) was initially a platform called Sabre. Sabre, like it’s current consumer-facing cousins Travelocity and Kayak created a digital inventory of available seats across all providers, allowing travel agents or travelers themselves to sort and filter through various preferences on a single screen and then book the “right” seat seamlessly.
The opportunity to align supply and demand more closely in healthcare mirrors the example from travel in many ways. Health systems need to think about their inventory of “seats” across multiple providers as they try to coordinate referrals across multiple different EHR platforms. Similarly, their “travel agents” and self-serve patients need accurate, real-time information that they can sort and filter through to find the “right” provider.
There is no question that finding a healthcare provider is harder than booking a seat - but it is far from impossible. It does require significant thought and investment around a centralized provider directory with sufficient detail to enable real-time routing of patients based on the specific clinical condition, geographic preferences, and insurance needs amongst other criteria. Best-in-breed directories encompass the following characteristics:
● Mechanisms for ensuring that key stakeholders can access the data (e.g., marketing teams, patient access coordinators, and providers themselves)
● Tools and processes to engage providers in profile development and maintenance (including individual practice focus at the condition level)
● Data governance to ensure compliance and freshness
● Analytics to provide visibility into network gaps and utilization patterns
Supply-side analytics can be especially powerful when married with information about the demand-side of the network. End-to-end scheduling systems can track every click and query that patients make, granting marketing teams incredible knowledge into patient desires and needs while enabling health systems to construct their provider networks to match that demand. Just as importantly, these scheduling platforms can drive enormous economic return through significant reductions in patient out-migration coupled with the better utilization of providers within the network.
In a world of market and business model uncertainty, why not at least begin to manage something that can be under our control?