Hospitals and health systems interested in building or strengthening their ambulatory care networks need to be prepared to challenge the status quo, according to Mark Coughlin, senior vice president of advisory services at Hammes Company. Ambulatory settings are quite different from inpatient ones, and require a different mindset and operating philosophy than most hospital or health system leaders are used to, he says. However, for hospitals and health systems to succeed in population health management, they must be willing to invest in new care models and break free from the modus operandi of only treating the sick.
Ambulatory facilities vs. hospitals
"Ambulatory care is a very different operating environment. It's a much more retail-focused mindset and requires different management capabilities [than hospitals]," Mr. Coughlin says. First, convenience and accessibility is a more important factor in consumers' decisions about outpatient centers than for inpatient care or hospitals' outpatient departments.
"If you look at traditional hospital service areas, they're based upon patients coming to them, not necessarily a broader geography," he says. "[But] patients don't want to drive across town; they want convenient access." Ambulatory facilities such as retail clinics and urgent care centers tend to be located near patients, such as in retail stores. Similarly, these clinics usually have longer hours than the typical hospital outpatient department.
In addition, the patient experience and efficiency of operations — short wait times and quick throughput — are more important for ambulatory facilities to attract patients than for hospitals, according to Mr. Coughlin.
4 questions to consider
Once hospitals understand the different mindset needed for operating outpatient centers, they should ask the following four questions before adopting an ambulatory network strategy, Mr. Coughlin says.
1. What do we want to accomplish? There are many reasons for establishing or expanding an ambulatory care network, including attracting patients to inpatient care, lowering costs, achieving a broader geographic reach and managing population health. Defining short- and long-term goals is a crucial step in developing an ambulatory care strategy. "What you want to accomplish with the network will have big implications for how you approach it," Mr. Coughlin says.
While feeding into inpatient care can be an acceptable short-term goal for ambulatory networks, hospitals and health systems should also consider a long-term goal of population health, according to Mr. Coughlin. "It's important to plan for the short term but to also size appropriately for the future. Don't overbuild an ambulatory network just to drive acute referrals," he says.
2. What is our relationship with the physician community? Hospitals and health systems should assess their current relationships with physicians and choose methods of alignment, such as employment, clinical integration or other models, as the type of physician relationship can influence the structure of the ambulatory network, according to Mr. Coughlin.
3. What are our capabilities? An evaluation of core financial and operational competencies can help hospital and health system leaders determine their ability to create an ambulatory network completely independently or in partnership with other providers.
4. What is the competitive environment? Finally, hospitals and health systems should look at the competitive environment to understand the current state of the market and to consider potential affiliations as part of ambulatory network development. Mr. Coughlin says hospitals and health systems should not be afraid to partner in this development, as an affiliation can have several benefits. First, in a market that is already overcapacity, affiliating with a provider can enable hospitals and health systems to help manage population health without spending resources unnecessarily. In addition, partnering with another provider can help fill any gaps in a hospital's or health system's capabilities.
Building a network
After hospitals and health systems answer these questions, the next step is to develop a comprehensive plan for approaching ambulatory network development. They need to set priorities based on the community's needs, which are partly determined by population demographics. For example, young, healthy patients may need more retail clinics and urgent care centers, whereas an older population with chronic conditions may need more patient-centered medical homes, Mr. Coughlin says.
The most carefully planned strategies will be worthless if they are not followed, however. Mr. Coughlin cautions against ideas that distract from the plan and overall goal. "They need to have the discipline to stick to the plan," he says of health system and hospital leaders.
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