Implementing an ambulatory care strategy is top of mind for hospital and health system leaders — especially as payers demand low-cost options, patients seek affordability and convenience, and new outside players enter the industry.
As the pressures from patients, payers and competitors mount, establishing a well-coordinated and defined ambulatory strategy is crucial to a healthcare organization's success. However, there are several imperatives organizations must consider to ensure the strategy is successful.
During a July 16 webinar sponsored by IBM Watson Health and hosted by Becker's Hospital Review, several leaders from IBM Watson discussed the pressures forcing hospitals to consider ambulatory strategies and the key considerations for ensuring these strategies are successful. The presenters were:
- Wes Rikkers, an IBM Watson Health national director of operational improvement
- Stacey Duke, an IBM Watson Health national director of operational improvement
- James Haulihan, associate partner on IBM Watson's provider consulting and analytics team
Why a well-designed outpatient strategy is critical
In the next decade, outpatient procedures are expected to increase by more than 15 percent, compared to inpatient discharges, which will experience growth of about 2 percent, Mr. Rikkers explained.
This push to the outpatient setting is attributable to the pressures from key stakeholders, including payers that are increasingly working to enter into value-based care contracts with providers; patients who are seeing high deductible health plans cut into their savings; and new competition making its way into the market promising to upend the industry. These challenges, coupled with other initiatives driving the rise of value-based care, are creating the need for a strategy to reduce costs and improve care that spreads beyond the inpatient, hospital setting.
"We've focused on the four walls of the hospital for so long … but if we are going to make a fundamental impact on our industry and the value we bring to the communities we serve … we need to rethink not just how, but where we are delivering care," Mr. Rikkers said.
Although the need for an outpatient strategy is vital to success under value-based care, providers should keep a few considerations in mind while designing an outpatient strategy.
Five key imperatives:
1. Spend time on forecasts and analysis to build a market strategy. While building an ambulatory strategy, it is crucial to understand the local market and the ins and outs of any potential expansion locations. To ensure an optimal placement of new facilities, leaders should analyze the competition in the area, project visit and procedure volumes, understand the patient population of the area and assess its future growth potential. In other words, it is vital to understand current market trends, while also anticipating the market needs of the future when building an ambulatory strategy. "The planning portion [to determine optimal locations] must be correct to allow you to invest with confidence and avoid the cost of making a bad decision," Mr. Haulihan explained.
2. Engage the entire patient population. In an ambulatory care setting, it is vital to ensure all patients are active, engaged and empowered, Mr. Haulihan explained. An effective strategy will not just have a plan for engaging patients with chronic illness — which drive the bulk of healthcare spending — but it will also be designed to engage patients without chronic conditions, which will ultimately improve outcomes and reduce costs in the future. Providers are good at treating patients that are seeking care; however, the challenge is engaging patients who aren't actively receiving proper medical care and may become chronic without it. "An engaged patient costs approximately 20 percent less to care for," Mr. Haulihan said.
3. Ensure care coordination extends beyond the inpatient setting. A key challenge of value-based care is managing, and accounting for, care delivered outside the four walls of a hospital given that providers are now accountable for an "encounter" instead of an "admission," Mr. Haulihan explained. It is now important to establish and carry through the care coordination structure to ambulatory care settings. Physician clinics and ambulatory care clinics should know how the care coordination strategies overlap between the inpatient and outpatient side.
4. Deliver more effective, lower-cost care by focusing on physicians AND patients. It is important to educate patients on the implications of a high deductible health plan to help them better understand the importance of preventative medicine and engaging with their primary care physician. "As part of that education, we need to help change the mindset of the patient who thinks the front door of a health system is the ED and instead [help] steer them to the lower cost entry points like urgent care centers and physician offices," Ms. Duke said. Additionally, delivering lower cost, effective care in an ambulatory setting also requires equipping physicians with the right tools. Physicians need data to support confident and efficient clinical decision making, explained Ms. Duke. When physicians are using evidence-based data to increase standardization of care, a reduction in medical errors and cost will follow.
5. Manage costs and increase efficiencies at all sites of care. The key imperative to ensuring a successful ambulatory strategy is maintaining financial sustainability of an organization. "You can be an organization that has the best clinical quality, but if you are doing it at a negative margin … it's not sustainable," Ms. Duke said. Financial sustainability is achieved by managing costs and increasing efficiencies at all sites of care. Healthcare organizations can ensure they are identifying key areas for cost improvement by comparative operational analysis and benchmarking.
Overall, especially as competition grows and patients and payers demand affordability, establishing well-designed, coordinated outpatient strategy will help providers navigate the challenges to succeed in a value-based care world.
To listen to the webinar, click here.