Becker's Hospital Review

20 Rethinking Ambulatory Strategy: 6 Key Challenges, Opportunities for Health Systems H ealth systems across the nation are exploring ways to reengi- neer their ambulatory strategy to enhance coordination, meet patient demand and ensure care continuity – all while reducing costs. As the industry shis from inpatient to outpatient care amid the transition from volume to value, health system executives are chal- lenged to ensure patients receive care in the appropriate setting, while simultaneously working to improve the quality of services of- fered. Developing a strong ambulatory strategy is one way provider organizations can move closer to reaching these key objectives. While 80 to 90 percent of healthcare spend occurs in the hospital, 85 percent of patient visits happen in the non-acute space, based on 2015 data from the CDC's National Center for Health Statistics. With such a large percentage of patients seeking care in non-acute settings, it's vital for health systems to find ways to efficiently pro- vide high-quality services at these care sites and design the opera- tional model to support the strategy. Ambulatory strategy challenges During the Executive Lead- ership Forum hosted by McKesson on Nov. 14 at the Becker's Hospi- tal Review 6th Annual CEO + CFO Roundtable in Chicago, a group of 18 health system executives discussed the greatest challenges they are facing in developing and executing their ambulatory strategy. 1. Provider organizations struggle to attract physicians. Several executives said their organizations are struggling to attract the talent necessary to expand their ambulatory care network. e COO of a nearly 900-bed California health system said difficulty attracting primary care physicians has stymied his organization's attempts to expand its primary care network. Smaller hospitals are also encountering this problem. e CFO of a 129-bed hospital in New York said his organization is facing challenges attracting pri- mary care physicians as well as specialty physicians. e issues cited by the two provider organizations during the lead- ership forum are representative of a nationwide trend. According to data from the Association of American Medical Colleges released earlier this year, the U.S. faces a shortage of up to 104,900 physicians by 2030. 2. Adding new physician groups presents challenges. Healthcare is becoming more value-focused, which requires health systems to create a culture that engages physicians in the health sys- tems' strategic objectives and more fully involves physicians in the facility's day-to-day operations. is is a difficult task, especially as health systems become more diverse and expand their networks by acquiring physician groups. During the Leadership Forum, the COO of an academic health sys- tem in the Midwest said his organization struggled to establish a sense of cohesion aer a recent merger. "[e] big challenge is learn- ing how to integrate the clinical hospital [group] with the ambulato- ry community group and how to integrate academic physicians with their ambulatory counterparts," he said. e vice president of medical affairs at an academic medical center in the Midwest echoed those challenges. He said his organization is learning how to "accommodate for the inevitable culture shock between academic physicians and community hospitals." Many health systems are likely to encounter challenges similar to those mentioned by the provider organizations at the leadership forum, as the rapid pace of merger and acquisition activity in the healthcare sector continues. Eighty-seven health system transac- tions had occurred as of the end of the third quarter of 2017, leading some industry experts to suggest the total number of deals this year may exceed the 102 transactions completed in 2016, according to a Kaufman, Hall & Associates analysis. As health systems seek to ex- pand their continuum of care, it is likely more partnerships between acute and non-acute providers will occur. Accenture predicts that non-acute providers will represent 84% of the total provider acquisition volume by 2018, while purchases of payers is expected to double. 3. HIT challenges are common. Whether pursuing a merger, acquisition or another type of partnership, health systems want a seamless integration, and technology plays a vital role in achieving this goal. Incompatible technology solutions can prevent provider organizations from realizing all the benefits they hope to achieve through the transaction. During the Leadership Forum, many executives identified HIT is- sues as the greatest challenge they are facing in executing their am- bulatory strategy. Several said their health systems have acquired physician practices that operate incompatible IT systems. e COO of a specialty hospital in the Midwest said this is an issue his or- ganization has encountered. "e challenge is that ambulatory care is a different platform. We're working on how to connect with the physicians from the organizations we just acquired," he said. Opportunities in ambulatory care Although health systems are facing many challenges in executing their ambulatory care strat- egies, the executives at the Leadership Forum also identified many opportunities in the ambulatory care space. 1. Prevent patient leakage. Health systems can improve qual- ity of care by expanding their ambulatory enterprise. Patients leak out of a health system when the system does not provide convenient access to services they need. is causes patients to receive unco- ordinated, fragmented care, which can lead to unnecessary testing and conflicting treatments. During the forum, many executives said their organizations are helping patients navigate their network to prevent patients from leaving for outside providers. Some executives said their organizations have invested in pa- tient-scheduling platforms to help prevent patient leakage. ese platforms allow patients to make future appointments before they walk out the door. e vice president of medical affairs at an ac- ademic medical center in the Midwest said his organization has nurse navigators to help keep patients from seeking care elsewhere. e nurse navigators understand what patients need and help con- nect them with the appropriate providers, which has helped signifi- cantly improve the patient experience. 2. Enhance efficiency with telehealth. As health systems ex- pand their ambulatory networks, many are using telehealth to bet- ter assist patients and boost revenue by maximizing the number of SPONSORED CONTENT

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