Becker's Hospital Review

61 Executive Briefing specialty ambulatory services in multiple locations and instead consolidate services into large multidisciplinary ambulatory destination centers. These ambulatory destination centers are not defined by their size (a large medical office building might have the same amount of space), but by the multidisciplinary ambulatory diagnostic and treatment operations they bring together in efficient scale off the hospital campuses. Health systems must rethink their ambulatory enterprises' focus on high-acuity, single-specialty procedural services and instead consider who controls their future patients' first healthcare touch points and how they will develop efficient multidisciplinary centers in markets distant from their hospitals. Rethinking Ambulatory Organizational Structures It has long been understood that ambulatory services require some separation from the hospital operating model to be successful. Yet many health systems are struggling to find the right leadership structures for their ambulatory enterprise. Without clear precedence, no bench of up-and-coming ambulatory leaders exists. Health systems wanting to drive the ambulatory agenda must change their ambulatory enterprise's structure and attract leaders with new skills. As the ambulatory enterprise comes to the forefront of healthcare delivery, the organizational structures must evolve to provide some autonomy to each health system division to serve the consumer's needs. However, with independence comes responsibility for the ambulatory enterprise to stand on its own financially and integrate care with the rest of the system. New ambulatory organizational structures require new leaders for the ambulatory enterprise. As long as the ambulatory enterprise is seen as a stepping stone for aspiring hospital CEOs, the ambulatory enterprise will not receive the long- term leadership focus it needs. Health systems must therefore reconsider who is leading their ambulatory enterprise. The leader must bring a long-term ambulatory focus and key capabilities: • An understanding of the retail health-consumer • A desire to create standardized, predictable and repeatable processes • A passion for lean operations As these new structures and ambulatory-focused leaders are developed, the types of partnerships needed to implement a successful ambulatory strategy also must be revisited. Rethinking Ambulatory Partners Traditionally, health systems have looked to specialty physicians as partners when developing ambulatory sites. Numerous examples exist of joint ventures with radiologists for imaging centers, surgeons for surgery centers, cardiologists for cardio-diagnostic centers, etc. Absent full-scale employment, these joint ventures will remain important. However, as healthcare consumers' influence grows and reimbursement models shift, the ambulatory enterprise needs new capabilities and thus different partners to succeed. As the ambulatory enterprise role changes, the new capabilities that are needed include: • Ability to segment populations by clinical and preferred time, access point and desired disease management approach • Strong understanding of consumerism, consumer purchase patterns and retail traffic patterns • New technology to allow asynchronous virtual primary care • Expertise in unscheduled, on-demand service delivery • Knowledge of the consumer definitions of convenience and service • CRM and ongoing relationship management capabilities • Downstream continuity and future care coordination/ scheduling tools As with other industries, many of these capabilities are tied to accessing, analyzing and managing information flow. Ambulatory partnerships must consider the new capabilities a potential partner brings, recognizing these capabilities are often found outside the traditional healthcare providers. Rethinking Ambulatory Financial Returns As the ambulatory enterprise grows and non-traditional partnerships are formed, ambulatory services can no longer be seen as a loss-leader feeding a profitable inpatient enterprise and instead, stand on their own financially. The transition becomes increasingly difficult when provider-based billing declines and ambulatory services are priced on the open market. Three steps are required to rethink the ambulatory financial model: 1. Live on outpatient rather than hospital-based pricing. Health systems should not leave money on the table, but instead recognize the hospital- based pricing arbitrage is rapidly coming to an end.

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